Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results: An observational study

Melissa R. Partin, Diana J. Burgess, James F. Burgess, Amy Gravely, David Haggstrom, Sarah E. Lillie, Sean Nugent, Adam A. Powell, Aasma Shaukat, Louise C. Walter, David B. Nelson

Research output: Contribution to journalArticle

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Abstract

Methods: We identified 74,104 patients with FOBT+ results from 98 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011, and followed them until September 30, 2011, for completion of colonoscopy. We identified patient characteristics from VHA administrative records, and organizational factors from facility surveys completed by primary care and gastroenterology chiefs. We estimated predictors of colonoscopy completion within 60 days and six months using hierarchical logistic regression models. Results: Thirty percent of patients with FOBT+ results received colonoscopy within 60 days and 49% within six months. Having gastroenterology or laboratory staff notify gastroenterology providers directly about FOBT+ cases was a significant predictor of 60-day [odds ratio (OR), 1.85; P = 0.01] and six-month follow-up (OR, 1.25; P = 0.008). Additional predictors of 60-day follow-up included adequacy of colonoscopy appointment availability (OR, 1.43; P = 0.01) and frequent individual feedback to primary care providers about FOBT+ referral timeliness (OR, 1.79; P = 0.04). Additional predictors of six-month follow-up included using guideline concordant surveillance intervals for low-risk adenomas (OR, 1.57; P = 0.01) and using group appointments and combined verbal-written methods for colonoscopy preparation instruction (OR, 1.48; P = 0.0001). Conclusion: Directly notifying gastroenterology providers about FOBT+ results, using guideline-concordant adenoma surveillance intervals, and using colonoscopy preparations instruction methods that provide both verbal and written information may increase overall follow-up rates. Enhancing follow-up within 60 days may require increased colonoscopy capacity and feedback to primary care providers. Impact: These findings may inform organizational-level interventions to improve FOBT+ follow-up.

Background: This study assessed the contribution of organizational structures and processes identified from facility surveys to follow-up for positive fecal occult blood tests [FOBT-positive (FOBT+)].

Original languageEnglish
Pages (from-to)422-434
Number of pages13
JournalCancer Epidemiology Biomarkers and Prevention
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2015

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Occult Blood
Hematologic Tests
Colonoscopy
Observational Studies
Odds Ratio
Gastroenterology
Veterans Health
Primary Health Care
United States Department of Veterans Affairs
Adenoma
Appointments and Schedules
Logistic Models
Guidelines
Health Facilities
Referral and Consultation

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results : An observational study. / Partin, Melissa R.; Burgess, Diana J.; Burgess, James F.; Gravely, Amy; Haggstrom, David; Lillie, Sarah E.; Nugent, Sean; Powell, Adam A.; Shaukat, Aasma; Walter, Louise C.; Nelson, David B.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 24, No. 2, 01.02.2015, p. 422-434.

Research output: Contribution to journalArticle

Partin, MR, Burgess, DJ, Burgess, JF, Gravely, A, Haggstrom, D, Lillie, SE, Nugent, S, Powell, AA, Shaukat, A, Walter, LC & Nelson, DB 2015, 'Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results: An observational study', Cancer Epidemiology Biomarkers and Prevention, vol. 24, no. 2, pp. 422-434. https://doi.org/10.1158/1055-9965.EPI-14-1170
Partin, Melissa R. ; Burgess, Diana J. ; Burgess, James F. ; Gravely, Amy ; Haggstrom, David ; Lillie, Sarah E. ; Nugent, Sean ; Powell, Adam A. ; Shaukat, Aasma ; Walter, Louise C. ; Nelson, David B. / Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results : An observational study. In: Cancer Epidemiology Biomarkers and Prevention. 2015 ; Vol. 24, No. 2. pp. 422-434.
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T1 - Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results

T2 - An observational study

AU - Partin, Melissa R.

AU - Burgess, Diana J.

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AU - Gravely, Amy

AU - Haggstrom, David

AU - Lillie, Sarah E.

AU - Nugent, Sean

AU - Powell, Adam A.

AU - Shaukat, Aasma

AU - Walter, Louise C.

AU - Nelson, David B.

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N2 - Methods: We identified 74,104 patients with FOBT+ results from 98 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011, and followed them until September 30, 2011, for completion of colonoscopy. We identified patient characteristics from VHA administrative records, and organizational factors from facility surveys completed by primary care and gastroenterology chiefs. We estimated predictors of colonoscopy completion within 60 days and six months using hierarchical logistic regression models. Results: Thirty percent of patients with FOBT+ results received colonoscopy within 60 days and 49% within six months. Having gastroenterology or laboratory staff notify gastroenterology providers directly about FOBT+ cases was a significant predictor of 60-day [odds ratio (OR), 1.85; P = 0.01] and six-month follow-up (OR, 1.25; P = 0.008). Additional predictors of 60-day follow-up included adequacy of colonoscopy appointment availability (OR, 1.43; P = 0.01) and frequent individual feedback to primary care providers about FOBT+ referral timeliness (OR, 1.79; P = 0.04). Additional predictors of six-month follow-up included using guideline concordant surveillance intervals for low-risk adenomas (OR, 1.57; P = 0.01) and using group appointments and combined verbal-written methods for colonoscopy preparation instruction (OR, 1.48; P = 0.0001). Conclusion: Directly notifying gastroenterology providers about FOBT+ results, using guideline-concordant adenoma surveillance intervals, and using colonoscopy preparations instruction methods that provide both verbal and written information may increase overall follow-up rates. Enhancing follow-up within 60 days may require increased colonoscopy capacity and feedback to primary care providers. Impact: These findings may inform organizational-level interventions to improve FOBT+ follow-up.Background: This study assessed the contribution of organizational structures and processes identified from facility surveys to follow-up for positive fecal occult blood tests [FOBT-positive (FOBT+)].

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