Electronic Reminder Increases Follow-Up Rates for Positive FOBT
Screening with fecal occult blood tests (FOBT) reduces colorectal cancer mortality by 15-33% and decreases the incidence of the disease by 20%; however, as many as 46-66% of patients with an abnormal FOBT do not receive proper diagnostic testing (e.g., follow-up colonoscopy). Research has shown that provider or system-based factors can predict appropriate follow-up, thus this study sought to determine the impact of an electronic reminder on the timeliness and proportion of patients referred to gastroenterology (GI) for evaluation after a positive FOBT. Using VA data, investigators compared GI consultation rates for 634 Veterans with a positive FOBT between July 18, 2004 and July 17, 2005 (pre-reminder) with rates for 468 Veterans with a positive FOBT between July 18, 2005 and July 18, 2006 (post-reminder).
Findings show that the electronic reminder was associated with a significant improvement in the proportion and timeliness of follow-up for Veterans with a positive FOBT. The intervention was associated with a 20.3% increase in gastroenterology consultations within 14 days, and the median time to colonoscopy decreased by 38 days (105 vs. 143 days). Study results also show that comorbidity was not significantly associated with any outcomes. The authors suggest that this systematic approach to patient care may lead to more timely diagnosis of CRC, with the potential for improved patient outcomes.
Larson M, Ko C, and Dominitz J. Effectiveness of a provider reminder on fecal occult blood test follow-up. Digestive Diseases and Sciences September 2009;54(9):1991-1996.
Drs. Dominitz and Larson are part of the VA Puget Sound Health Care System in Seattle; Dr. Dominitz also is part of HSR&D’s Northwest Center for Outcomes Research in Older Adults.