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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1063 — Improving Follow-Up after a Positive Colorectal Cancer Screening Test: An Evaluation of the C4 Collaborative

Powell AA (Minneapolis VA Center for Chronic Disease Outcomes Research (CCDOR)), Nugent S (Minneapolis VA Center for Chronic Disease Outcomes Research (CCDOR)), Ordin DL (VHA Office of Quality and Performance (OQP)), Noorbaloochi S (Minneapolis VA Center for Chronic Disease Outcomes Research (CCDOR)), Partin MR (Minneapolis VA Center for Chronic Disease Outcomes Research (CCDOR))

Objectives:
In 2005 VHA initiated a year-long Colorectal Cancer Care Collaborative (C4) to improve the timeliness of follow-up after positive fecal occult blood colorectal cancer screening tests (+FOBT). This analysis evaluates pre-post change in the timeliness of colonoscopy procedures following a +FOBT at participating facilities.

Methods:
Twenty-one facilities formed local quality improvement teams, received quality improvement training, and implemented process changes. Learning was shared across teams on an ongoing basis. We conducted an evaluation of pre-post change in the timeliness of follow-up among participating facilities. The primary outcome measure was pre-post change in the percent of patients receiving a follow-up colonoscopy within 60 days of +FOBT among all patients receiving a colonoscopy within a year. Secondary measures included the percent of patients receiving a colonoscopy within one year of +FOBT and average days to colonoscopy. Team characteristics and change strategies were examined as possible correlates with facility-level improvement.

Results:
There was significant improvement in the percent receiving a colonoscopy within 60 days (26% pre-C4 versus 38% post-C4), the percent receiving a colonoscopy within one year (33% pre-C4 versus 43% post-C4), and the average days to colonoscopy (129.9 days pre-C4 versus 104.8 days post-C4). Improvement in the 60-day measure was significant at 12 of the 21 facilities. Teams with the most improvement established clear roles and goals, had previous QI experience, made more use of quality improvement tools, and incorporated primary care education efforts into their improvement work.

Implications:
The VHA’s FOBT follow-up quality improvement collaborative appears to have had an overall positive effect; however, benefits of participation were not realized by all facilities.

Impacts:
Multi-site collaboratives have the potential to improve the timeliness of follow-up after a positive CRC screening test. The likelihood of successes may be enhanced by establishing experienced QI teams with clear goals and roles who understand and use established quality improvement tools. Teams should consider incorporating primary care education efforts into their improvement plan.


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