Improvement in the Diagnostic Evaluation of a Positive Fecal Occult Blood Test in an Integrated Health Care Organization

Abstract

Background Screening for fecal occult blood can be effective in reducing colorectal cancer mortality only if positive tests are appropriately followed up with complete diagnostic evaluation (i.e., colonoscopy or flexible sigmoidoscopy with double contrast barium enema) and treatment. Objectives To examine whether rates of complete diagnostic evaluation following a positive fecal occult blood test (FOBT) have improved over time after the implementation of tracking systems and physician guidelines within a large integrated health care organization. Research Design From 1993 to 2005, 8513 positive FOBTs were identified on 8291 enrollees aged 50–79 of a large health care system. Automated records were used to identify repeat FOBTs, colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema within one year after the positive FOBT. National rates of complete diagnostic evaluation were estimated from the 2005 National Health Interview Survey. Results In this integrated health care organization, the percentage of positive FOBTs followed by complete diagnostic evaluation within one year increased from 57%–64% in 1993–1996 to 82%–86% from 2000–2005. Use of repeat FOBT following a positive FOBT decreased from 28–31% in 1993–1996 to 6–11% in 2000–2005. Based on the National Health Interview Survey, only 52% of positive FOBTs from 2000–2005 were followed by complete diagnostic evaluation nationally. Conclusions Adherence to recommendations for complete diagnostic evaluation following a positive FOBT has greatly improved over time in an integrated group medical practice. Through the use of tracking systems and screening guidelines, it may be possible to reach levels of follow-up that are comparable to those observed in randomized trials.

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial (Preprint)

“…However, others suggested that women are less likely than men are to undergo follow-up testing [24,55,16]. In our study, we found a difference between genders in the intervention group.…”

“…Barriers to follow-up after a positive FOBT have been identified in the literature [17][18][19][20][21][22] and are divided into four general groups based on whether they are related to patients, physicians, providers, or information technology [23][24][25]. Intervention programs have been developed to target each of these groups [26].…”

Longitudinal Adherence With Fecal Occult Blood Test Screening in Community Practice

“…The plan processes all 3-card FOBTs within central laboratories, which record results in electronic databases. Although the plan used an automated system to notify primary care physicians when patients did not receive timely colonoscopy after abnormal FOBT results, 11 …”

A Centrally Generated Primary Care Physician Audit Report Does Not Improve Colonoscopy Uptake After a Positive Result on a Fecal Occult Blood Test in Ontario’s Coloncancercheck Program

“…In the United States, Veteran Affairs centres and a large Seattle-based health cooperative found that electronic reminders prompting physician feedback [3][4][5] , in addition to other infrastructure upgrades 4 , improved colonoscopy uptake after an abnormal fobt. Another U.S. study found that physician reminders, combined with practice-tailored education, improved the same outcome 6 .…”