BACKGROUND/RATIONALE:
Colorectal Cancer (CRC) is the third most common cancer among men and women, and ranks second among causes of cancer deaths. Early detection of CRC can significantly reduce population rates of CRC mortality, and current CRC screening guidelines recommend that all individuals age 50 and older receive timely CRC screening. Unfortunately, recent data from the VA Office of Quality and Performance suggest that, on average, 40% of VA patients fail to receive timely CRC screening, and little is known about compliance with CRC follow-up recommendations. Significant improvements in screening and follow-up rates can only be achieved with thorough knowledge of variations in recommended CRC screening and follow-up practice. Current VA data systems do not directly support patient-centered monitoring of CRC screening and follow-up. Hence, a new, centralized colorectal cancer screening and follow-up data system is needed that will facilitate access to relevant data from multiple sources, while at the same time establishing and maintaining data quality, integrity, and security.

OBJECTIVE(S):
The long term goal of this project is to develop and implement a valid and efficient national Veterans Affairs (VA) data system that can be used to: (1) assess and monitor adherence to recommended colorectal cancer (CRC) screening and follow-up practices and their outcomes in the VA, (2) inform and facilitate interventions to improve CRC screening and follow-up practices, and (3) evaluate specific improvement strategies. The immediate objectives are to: (1) develop a data system prototype, using a sample of VA facilities, (2) develop and validate operational definitions of recommended screening and follow-up practices using VA and Medicare data, and (3) develop a functional approach for obtaining, linking and managing the components of this data system on a national scale.

METHODS:
The data system focuses on four VA facilities (Durham, Minneapolis, Portland and Sepulveda VAMC). A finder file of eligible veterans using or living within the service area of the four test sites is used to gather relevant demographics, comorbidities and CRC screening and follow-up data from national datasets (Austin in patient and out patient, BIRLS), Medicare, and VISTA records from the four test sites. Operational definitions of colorectal screening and follow-up compliance are developed and validated.

FINDINGS/RESULTS:
Preliminary finding indicate a high degree of cross-utilization of multiple VA facilities which directly affects estimates of CRC screening and follow-up. For example, among veterans receiving care at the 4 test sites during fiscal years 2001-2002, 27% of those receiving Fecal Occult Blood Test (FOBT) screening obtained that screening at VA facilities other than the 4 test sites. Findings are similar for other screening modalities. These findings underscore the importance of calculating screening and follow-up rates on a cross-facility, patient-centered basis, rather than relying on current facility-based methods. While screening rates may be readily computed using national Austin data, screening results, follow-up details, and pathology data are only accessible through the VISTA system. The applicability of the CRC data system to problems of follow-up and diagnosis will be limited by current administrative constraints to accessing these data.

IMPACT:
The data system resulting from this project will provide a foundation for future CRC screening and follow-up quality improvement efforts and can be used to: (1) assess national and local adherence to recommended CRC screening and follow-up practices on an annual basis, (2) identify gaps in recommended practices, (3) facilitate evaluation of strategies for reducing these gaps, and (4) trigger computerized notification and prompting strategies for enhancing compliance with recommended CRC practices.

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External Links for this Project

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PUBLICATIONS:

Conference Presentations

1. Kochevar LK. Measuring Quality in Colorectal Cancer Diagnosis and Care. Paper presented at: Advance Clinic Access Steering Committee Annual Meeting; 2005 May 5; Washington, DC. [view]
2. Kochevar LK. Measuring Quality in Colorectal Cancer Diagnosis and Care. Paper presented at: VA Office of Quality and Performance and Office of Patient Care Services Leadership Conference; 2005 Mar 1; Washington, DC. [view]
3. Kochevar LK. Measuring Quality in Colorectal Cancer Diagnosis and Care. Paper presented at: VA Quality Improvement Annual Council; 2005 Apr 6; Washington, DC. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Diagnosis, Treatment - Observational
Keywords: Cancer, Quality assurance, improvement, Screening
MeSH Terms: Health Behavior, Practice Guidelines, Feasibility Studies, Population Surveillance, Veterans Disability Claims, Neoplasms, Database Management Systems