Colorectal Cancer Screening in Veterans Receiving Primary Care in VA Medical Centers and VA Community Clinics

Malhotra A, Vaughan-Sarrazin MS, Charlton ME, Rosenthal GE. Colorectal Cancer Screening in Veterans Receiving Primary Care in VA Medical Centers and VA Community Clinics. Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.

Objectives: Compare colorectal cancer (CRC) screening/surveillance rates in Veterans receiving primary care in community-based outpatient clinics (CBOCs) and VA medical centers (VAMCs). Methods: The VA Outpatient Care Files were used to identify 3,925,814 patients > 50 years with > 1 primary care (PC) visits in 2010. ICD-9-CM and CPT codes identified Veterans undergoing screening/surveillance colonoscopy, sigmoidoscopy, fecal occult blood testing (FOBT), and double-contrast barium enema (DCBE). Patients were categorized as VAMC (n = 1,899,267; 48%) or CBOC (2,026,547; 52%) based where most PC encounters occurred, and as high (n = 353,580) or average (n = 3,572,234) risk based on CRC risk factors and validated ICD-9-CM based algorithms. Results: CBOC patients were older than VAMC patients (mean ages, 69.3 vs. 67.4 years; p < .001), more likely (p < .001) to be male (96.7% vs. 95.2%) and white (83.8% vs. 73.6%), but less likely (p < .001) to be high-risk [8.5% vs. 9.5%). Rates of colonoscopy, sigmoidoscopy, and DCBE were lower (p < .001) in CBOC patients. Among high-risk patients, rates of screening/surveillance by colonoscopy, sigmoidoscopy, and DCBE were 18.3%, 0.8%, and 0.5%, respectively, in CBOCs, compared to 25.4%, 1.2%, and 0.7% in VAMCs. Among average-risk patients, these rates were 1.0%, 0.1%, and 0.1% in CBOC, and 1.6%, 0.2%, and 0.2% in VAMCs. The differences remained after adjusting for age and comorbidity. For example, the adjusted odds of colonoscopy for CBOC patients were 0.67 (95% CI, 0.57 to 0.79) for average, and 0.74 (95% CI, 0.64 to 0.86) for high-risk patients. In contrast, use of FOBT was relatively similar in CBOCs and VAMCs among both high (10.3% vs. 10.7%) and average-risk (12.8% vs. 12.7%) patients. Interestingly, although high-risk patients accounted for 9% of all patients, they received 62% of all screening/surveillance colonoscopies. Implications: CBOC patients are less likely to receive screening/surveillance colonoscopy, sigmoidoscopy, and DCBE than VAMC patients. The lower rates in CBOC patients were not offset by higher use of screening FOBT. Impacts: CBOC patients are less likely to receive screening/surveillance colonoscopy, sigmoidoscopy, and DCBE than VAMC patients. The lower rates in CBOC patients were not offset by higher use of screening FOBT.