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HSR&D 2004 National Meeting Abstracts

1009. Evaluation of a Positive Screening Fecal Occult Blood Test (WC=242)
Deborah A Fisher, MD, MHS, Durham VAMC, A Jeffreys, Durham VAMC, C Coffman, Durham VAMC

Objectives: Compliance with full colon evaluation (FCE) for positive fecal occult blood test (FOBT) is unknown in the VA system but has been inadequate in non-VA studies. The aim of this study was to measure compliance with guidelines and identify potential barriers to FCE.

Methods: Medical record review of all patients at our facility over the age of 50 with a positive screening FOBT from March 1, 2000 to February 28, 2001 was conducted. Patient demographics, dates of ordering and performing follow-up test(s), and compliance with scheduled procedures were collected. The primary outcome was performance of a FCE, defined as a colonoscopy or double contrast barium enema (DCBE), within 12 months.

Results: The average age was 67; 98% men; 57% white; 29% black (n=601). Seventy-four percent had a GI consult. Only 40%, however, had a FCE within 12 months; 67% colonoscopy; 21% DCBE; 12% both. The average time to FCE was 276 days for colonoscopy and 218 days for DCBE. Twenty percent of patients canceled (14%) or failed to appear for (6%) a procedure.

Conclusions: A quarter of the patients did not have a GI consult ordered. Less than half of the patients with a positive FOBT had a FCE within 12 months. The average time from positive FOBT to follow-up procedure was 7-9 months. Patient non-adherence also contributed to incomplete CRC evaluation.

Impact: Automatic GI consults, provider reminder systems, and increased staffing at the GI clinics may improve CRC screening follow-up.