Diagnostic Evaluation of Patients Presenting to Primary Care with Rectal Bleeding

Abstract

Diagnostic evaluation of patients presenting to primary care with rectal bleeding may be suboptimal because of inadequate risk factor assessment and prioritization of patients' other concurrent medical problems.

Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study

“…These practices participated in two learning collaboratives between 2012 and 2016: the first aimed to establish or strengthen team-based care (2012-2014), and the second (2014-2016) aimed to improve preventive cancer screening processes for breast and colorectal cancer. 15,22,23…”

“…[12][13][14] The quality of diagnostic evaluation is also increasingly a focus of ambulatory quality improvement efforts. 8,15,16 Variable quality has been noted in primary care evaluations for both breast lumps 17 and rectal bleeding. 15,18,19 However, breast lump and rectal bleeding evaluations have rarely been examined within the same practices, limiting investigation into potential differences and contributing factors.…”

“…8,15,16 Variable quality has been noted in primary care evaluations for both breast lumps 17 and rectal bleeding. 15,18,19 However, breast lump and rectal bleeding evaluations have rarely been examined within the same practices, limiting investigation into potential differences and contributing factors. 16,20 One trial of patient navigation in 11 clinics found that patients with rectal bleeding or positive fecal occult blood tests were less likely to achieve diagnostic resolution than patients with breast concerns.…”

“…We previously found that only half of patients presenting with rectal bleeding within 15 primary care practices received recommended diagnostic evaluation. 15 The goal of the current study was to compare the quality of diagnostic evaluations performed for patients with rectal bleeding to those performed for patients with breast lumps in those same 15 practices in order to understand how the practices performed on different diagnostic processes and determine the extent to which the evaluation of rectal bleeding may present unique challenges. Specifically, we compare the degree to which patients with a breast lump or with rectal bleeding receive diagnostic evaluations concordant with available decision support tools 10,21 and the timeliness of completion of these evaluations.…”

General Internists in Pursuit of Diagnostic Excellence in Primary Care: a #ProudtobeGIM Thread That Unites Us All

“…Analyzing crosssectional medical record review data from 300 adults presenting with rectal bleeding to academic primary care practices, they found that although almost 90% required colonoscopy as indicated by clinical practice guidelines, orders were placed for only 74%. 4 Of those patients, less than 60% ended up having a colonoscopy within a year. The odds of physicians ordering recommended colonoscopies were significantly lower in patients 40-50 years and in patients with additional primary care visits unrelated to rectal bleeding.…”