Study Examines Strategies to Improve Follow-Up for Positive CRC Screening
Screening programs aimed at early diagnosis of cancer have proven to reduce both the incidence and mortality related to colorectal cancer (CRC). The fecal occult blood test (FOBT) is used for most VA patients screened for CRC. To benefit from this screening, positive results should be followed with a diagnostic colonoscopy. In 2006, VA launched a national effort to increase the proportion of patients receiving a colonoscopy within 60 days of a positive FOBT lab result. This study sought to determine the proportion of VA patients at 133 VAMCs with a positive FOBT between March and June of 2007 that received a colonoscopy within 60 days. Investigators also examined data from a 2007 web-based survey that was completed by 132 VAMCs on their FOBT follow-up quality improvement strategies. Survey participants were asked the degree to which their facility had implemented each of 16 strategies to improve follow-up of positive FOBTs. Three types of strategies were assessed: 1) developing quality improvement (QI) infrastructure; 2) improving care delivery processes, and 3) building gastroenterology capacity.
Results show that only 1 in 4 Veterans received follow-up colonoscopies within 60 days of a positive FOBT for colorectal cancer screening. Findings also show that developing QI infrastructure appears to be an effective strategy for improving FOBT follow-up, when this work is followed by process improvements (e.g., strategies to decrease cancellations, revise colonoscopy prep education protocols). On average, facilities indicated that they had fully implemented 6.84 of the 16 improvement strategies. The number of strategies fully implemented was positively associated with 60-day follow-up. The most commonly cited barriers to improvement involved capacity constraints, e.g., sites listing insufficient gastroenterology staff as a barrier had a lower percentage of Veterans receiving timely follow-up. However, none of the improvement strategies designed to address gastroenterology capacity constraints were associated with timely follow-up, suggesting that this barrier may be more difficult or take more time to address than process inefficiencies.
Powell A, Gravely A, Ordin D, Schlosser J, and Partin M. Timely follow-up of positive fecal occult blood tests: Strategies associated with improvement. American Journal of Preventive Medicine August 2009;37(2):87-93.
This study was supported through VA/HSR&D’s Quality Enhancement Research Initiative (QUERI). Drs. Powell and Partin and Ms. Gravely are part of HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis, MN.