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CDA 07-016 – HSR Study

CDA 07-016
Patterns of Follow-up Care Among Colorectal Cancer Survivors
David A Haggstrom, MD
Richard L. Roudebush VA Medical Center, Indianapolis, IN
Indianapolis, IN
Funding Period: February 2008 - January 2013
A veteran is a cancer survivor from the time of diagnosis, through the balance of his/her life. This project is developing quality of survivorship care measures, and assessing models of coordinated survivorship care. The research plan proposed here broadens the VA portfolio by addressing cancer care post-treatment.

Aim 1: To identify patient-level characteristics associated with underuse and overuse of guideline-concordant care among veteran colorectal cancer (CRC) survivors. Aim 2: To determine whether organizational factors or physician specialty are associated with the quality of CRC surveillance care. Hypothesis 2a: There is no difference in the quality of surveillance care between primary care and specialty physicians. Hypothesis 2b: More organizational oncology care resources are associated with overuse of non-guideline-concordant surveillance care. Aim 3: To develop and pilot test a CRC survivor's personal health record (PHR) that promotes guideline-concordant care.

A longitudinal cohort study was performed using CRC patients identified in the VA Central Cancer Registry (VACCR). Cancer cases werelinked with VA national administrative data and organizational surveys to determine whether patient, provider, or organizational characteristics are associated with the quality of surveillance care. A CRC PHR prototype was developed to meet the patient-centered needs of CRC survivors. Usability test participants were recruited from among Veterans, providers, and caregivers.

Not yet available.

Findings indicate potential gaps and targets to improve the quality of CRC surveillance care received by veterans. Operational partners responsible for cancer care delivery have been engaged during the course of the CDA, including the VA Cancer Survivorship Interest Group and My HealtheVet Clinical Advisory Board. Dr. Haggstrom anticipates future implementation research projects related to cancer survivorship and surveillance care, including personal health records (PHRs) and care models that coordinate primary care and oncology providers serving Veterans. In addition, the PHR prototype will provide meaningful information to guide the development of patient-centered information technology for Veterans, in particular, cancer survivors.

External Links for this Project

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Journal Articles

  1. Haggstrom DA, Weiner M. A colorectal cancer survivor's personal health record. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2011 Oct 26; 10(2):1787. [view]
  2. Partin MR, Powell AA, Burgess DJ, Haggstrom DA, Gravely AA, Halek K, Bangerter A, Shaukat A, Nelson DB. Adding Postal Follow-Up to a Web-Based Survey of Primary Care and Gastroenterology Clinic Physician Chiefs Improved Response Rates but not Response Quality or Representativeness. Evaluation & the health professions. 2015 Sep 1; 38(3):382-403. [view]
  3. Haggstrom DA, Taplin SH, Monahan P, Clauser S. Chronic Care Model implementation for cancer screening and follow-up in community health centers. Journal of health care for the poor and underserved. 2012 Aug 1; 23(3 Suppl):49-66. [view]
  4. Jackson GL, Powell AA, Ordin DL, Schlosser JE, Murawsky J, Hersh J, Ponte G, Zullig LL, Erb F, Parlier R, Haggstrom DA, Koets N, Mills PD, Francis J, Kelley MJ, Davies ML, Provenzale D, VA Colorectal Cancer Care Planning Committee Members. Developing and sustaining quality improvement partnerships in the VA: the Colorectal Cancer Care Collaborative. Journal of general internal medicine. 2010 Jan 1; 25 Suppl 1:38-43. [view]
  5. Flanagan M, Arbuckle N, Saleem JJ, Militello LG, Haggstrom DA, Doebbeling BN. Development of a workflow integration survey (WIS) for implementing computerized clinical decision support. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2013 Jun 26; 2011:427-34. [view]
  6. Nazi KM, Hogan TP, Wagner TH, McInnes DK, Smith BM, Haggstrom D, Chumbler NR, Gifford AL, Charters KG, Saleem JJ, Weingardt KR, Fischetti LF, Weaver FM. Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system. Journal of general internal medicine. 2010 Jan 1; 25 Suppl 1:62-7. [view]
  7. Haggstrom DA, Saleem JJ, Militello LG, Arbuckle N, Flanagan M, Doebbeling BN. Examining the relationship between clinical decision support and performance measurement. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2009 Nov 14; 2009:223-7. [view]
  8. French DD, Bradham DD, Campbell RR, Haggstrom DA, Myers LJ, Chumbler NR, Hagan MP. Factors associated with program utilization of radiation therapy treatment for VHA and medicare dually enrolled patients. Journal of community health. 2012 Aug 1; 37(4):882-7. [view]
  9. Haggstrom DA, Arora NK, Helft P, Clayman ML, Oakley-Girvan I. Follow-up care delivery among colorectal cancer survivors most often seen by primary and subspecialty care physicians. Journal of general internal medicine. 2009 Nov 1; 24 Suppl 2:S472-9. [view]
  10. Vachon E, Robb BW, Haggstrom DA. Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study. JMIR cancer. 2022 Aug 11; 8(3):e34851. [view]
  11. Chumbler NR, Haggstrom D, Saleem JJ. Implementation of health information technology in Veterans Health Administration to support transformational change: telehealth and personal health records. Medical care. 2011 Dec 1; 49 Suppl:S36-42. [view]
  12. Haggstrom DA, Saleem JJ, Russ AL, Jones J, Russell SA, Chumbler NR. Lessons learned from usability testing of the VA's personal health record. Journal of the American Medical Informatics Association : JAMIA. 2011 Dec 1; 18 Suppl 1:i13-7. [view]
  13. Partin MR, Burgess DJ, Burgess JF, Gravely A, Haggstrom D, Lillie SE, Nugent S, Powell AA, Shaukat A, Walter LC, Nelson DB. Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results: an observational study. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2015 Feb 1; 24(2):422-34. [view]
  14. Sehdev A, Sherer EA, Hui SL, Wu J, Haggstrom DA. Patterns of computed tomography surveillance in survivors of colorectal cancer at Veterans Health Administration facilities. Cancer. 2017 Jun 15; 123(12):2338-2351. [view]
  15. Shimada SL, Brandt CA, Feng H, McInnes DK, Rao SR, Rothendler JA, Haggstrom DA, Abel EA, Cioffari LS, Houston TK. Personal health record reach in the Veterans Health Administration: a cross-sectional analysis. Journal of medical Internet research. 2014 Dec 12; 16(12):e272. [view]
  16. Sima JL, Perkins SM, Haggstrom DA. Primary care physician perceptions of adult survivors of childhood cancer. Journal of pediatric hematology/oncology. 2014 Mar 1; 36(2):118-24. [view]
  17. Saleem JJ, Militello LG, Arbuckle N, Flanagan M, Haggstrom DA, Linder JA, Doebbeling BN. Provider perceptions of colorectal cancer screening clinical decision support at three benchmark institutions. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2009 Nov 14; 2009:558-62. [view]
  18. Haggstrom DA, Doebbeling BN. Quality measurement and system change of cancer care delivery. Medical care. 2011 Dec 1; 49 Suppl:S21-7. [view]
  19. Saleem JJ, Haggstrom DA, Militello LG, Flanagan M, Kiess CL, Arbuckle N, Doebbeling BN. Redesign of a computerized clinical reminder for colorectal cancer screening: a human-computer interaction evaluation. BMC medical informatics and decision making. 2011 Nov 29; 11:74. [view]
  20. Militello LG, Arbuckle NB, Saleem JJ, Patterson E, Flanagan M, Haggstrom D, Doebbeling BN. Sources of variation in primary care clinical workflow: implications for the design of cognitive support. Health Informatics Journal. 2014 Mar 1; 20(1):35-49. [view]
  21. Yabroff KR, Saraiya M, Meissner HI, Haggstrom DA, Wideroff L, Yuan G, Berkowitz Z, Davis WW, Benard VB, Coughlin SS. Specialty differences in primary care physician reports of papanicolaou test screening practices: a national survey, 2006 to 2007. Annals of internal medicine. 2009 Nov 3; 151(9):602-11. [view]
  22. Haggstrom DA, Imperiale TF. Surveillance approaches among colorectal cancer survivors after curative-intent. Minerva Gastroenterologica E Dietologica. 2009 Dec 1; 55(4):483-500. [view]
  23. Yabroff KR, Zapka J, Klabunde CN, Yuan G, Buckman DW, Haggstrom D, Clauser SB, Miller J, Taplin SH. Systems strategies to support cancer screening in U.S. primary care practice. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2011 Dec 1; 20(12):2471-9. [view]
  24. Haggstrom DA, Clauser SB, Taplin SH. The health disparities cancer collaborative: a case study of practice registry measurement in a quality improvement collaborative. Implementation science : IS. 2010 Jun 4; 5:42. [view]
  25. Meissner HI, Tiro JA, Yabroff KR, Haggstrom DA, Coughlin SS. Too much of a good thing? Physician practices and patient willingness for less frequent pap test screening intervals. Medical care. 2010 Mar 1; 48(3):249-59. [view]
  26. Haggstrom DA, Carr T. Uses of Personal Health Records for Communication Among Colorectal Cancer Survivors, Caregivers, and Providers: Interview and Observational Study in a Human-Computer Interaction Laboratory. JMIR human factors. 2022 Jan 25; 9(1):e16447. [view]
  27. Haggstrom DA, Rosenman M, Myers LJ, Teal E, Doebbeling BN. VA-INPC: Linking Department of Veterans Affairs (VA) and Indiana Network for Patient Care (INPC) data to assess surveillance testing among veterans with colorectal cancer. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2010 Nov 13; 2010:266-70. [view]
  28. Haggstrom DA, Klabunde CN, Smith JL, Yuan G. Variation in primary care physicians' colorectal cancer screening recommendations by patient age and comorbidity. Journal of general internal medicine. 2013 Jan 1; 28(1):18-24. [view]
Journal Other

  1. Haggstrom DA, Carney TJ. Cancer care disparities: research regarding timeliness and potential coordination. [Editorial]. The American journal of managed care. 2009 Nov 1; 15(11):778-80. [view]

  1. Goldzweig CL, Towfigh AA, Paige NM, Orshansky G, Haggstrom DA, Beroes JM, Miake-Lye I, Shekelle PG. Systematic Review: Secure Messaging Between Providers and Patients, and Patients’ Access to Their Own Medical Record: Evidence on Health Outcomes, Satisfaction, Efficiency and Attitudes. Washington, DC: Department of Veterans Affairs VA Evidence-based Synthesis Program Reports; 2012. [view]
Book Chapters

  1. Haggstrom DA, Kahi CJ. Colonoscopy after Colon Cancer Resection. In: Waye JD, Rex DK, Williams CB, editors. Colonoscopy: Principles and Practice (2nd Edition). 2nd ed. Oxford, UK: Blackwell Publishing Ltd; 2009. Chapter 55. [view]

  1. Haggstrom DA, Cheung W. Approach to the long-term survivor of colorectal cancer. Online: Wolters Kluwer Health; 2012 Mar 2. [view]
VA Cyberseminars

  1. Weiner M, Russ AL, Haggstrom DA. The Status of Health Information Exchange in the VA. [Cyberseminar]. 2012 Sep 24. [view]
Conference Presentations

  1. Weiner M, Haggstrom DA. A colorectal cancer survivor's personal health record. Paper presented at: American Medical Informatics Association Annual Symposium; 2011 Oct 25; Washington, DC. [view]
  2. Chumbler NR, Haggstrom DA, Russell S, Saleem JJ, Russ AL. A novel tool to track and analyze qualitative usability data: Lessons learned from the VA's personal health record. Paper presented at: Human Factors and Ergonomics Society Annual Meeting; 2010 Sep 27; San Francisco, CA. [view]
  3. Saleem JJ, Doebbeling BN, Flanagan ME, Haggstrom DA, Woodward-Hagg HK, Yano. Approaches to Design and Implementation of Clinical Decision Support in the VA: Relationship to Staff Sufficiency. Paper presented at: VA HSR&D National Meeting; 2008 Feb 14; Baltimore, MD. [view]
  4. Haggstrom DA. Cancer survivorship: Care Planning and Delivery Models. Paper presented at: Association of VA Hematology/Oncology Annual Meeting; 2008 Sep 14; Nashville, TN. [view]
  5. Haggstrom DA. Colorectal Cancer Survivorship, Surveillance Care, and Personal Health Records. Paper presented at: RWJ Foundation Physician Faculty Scholars Program National Meeting; 2011 Dec 1; San Diego, CA. [view]
  6. Haggstrom DA, Doebbeling BM, Jones LE, Yano EM. Degree of Cancer Care Coordination among Primary Care, Gastroenterology, and Oncology through Service Agreements. Poster session presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC. [view]
  7. Haggstom A, Doebbeling N, Yano M. Degree of Cancer Care Coordination among Primary Care, Gastroenterology, and Oncology through Service Agreements. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD. [view]
  8. Haggstrom DA, Phelan SP, Yeazel MW, Arora NK, Clauser SB, Jackson GL, Provenzale D. Impact of Co-Location of Primary and Specialty Care upon Informational Awareness and Decision-Making of Primary Care from Cancer Patients' Perspective. Presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD. [view]
  9. Haggstrom DA. Implementation of the Chronic Care Model in the HRSA Health Disparities Cancer Collaborative. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2008 Apr 9; Pittsburgh, PA. [view]
  10. Haggstrom DA, Arora K, Oakley-Girvan. Primary and subspecialty care models of follow-up care delivery among colorectal cancer survivors. Poster session presented at: American Society of Clinical Oncology Annual Meeting; 2009 Jun 5; Chicago, IL. [view]
  11. Haggstrom DA. Screening in Primary Care: How do Physicians and Systems Address Patient Comorbidity and Preferences? Paper presented at: Prevent Cancer Foundation Dialogue for Action on Colorectal Cancer Screening: Today’s Progress, Tomorrow’s Challenge Assembly; 2012 Mar 1; Baltimore, MD. [view]
  12. Haggstrom DA, Yeazel M, Clauser S, Arora N, Finstad D, Phalen S, Jackson G, van Ryn M. Who prescribes medications for symptom management and what is the impact of survivorship care plans among colorectal cancer survivors in the VA? Paper presented at: Cancer and Primary Care Research International Network Annual Meeting; 2012 Jun 6; Cleveland, OH. [view]

DRA: Digestive Diseases, Health Systems, Cancer
DRE: Prognosis
Keywords: none
MeSH Terms: none

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