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Showing content from https://pubmed.ncbi.nlm.nih.gov/28493543/ below:

Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results

. 2017 Sep 15;123(18):3502-3512. doi: 10.1002/cncr.30765. Epub 2017 May 11. Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results

Affiliations

¹ Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
² Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
³ Center for Healthcare Organization and Implementation Research, Boston Veterans Affairs Healthcare System, Boston, Massachusetts.
⁴ Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
⁵ Veterans Affairs Health Services Research & Development Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.
⁶ Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
⁷ Division of Geriatrics, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California.

PMID: 28493543
PMCID: PMC5589505
DOI: 10.1002/cncr.30765

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Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results

Melissa R Partin et al. Cancer. 2017.

. 2017 Sep 15;123(18):3502-3512. doi: 10.1002/cncr.30765. Epub 2017 May 11. Authors Melissa R Partin^{1 2}, Amy A Gravely¹, James F Burgess Jr^{3 4}, David A Haggstrom^{5 6}, Sarah E Lillie^{1 2}, David B Nelson^{1 2}, Sean M Nugent¹, Aasma Shaukat^{1 2}, Shahnaz Sultan^{1 2}, Louise C Walter⁷, Diana J Burgess^{1 2} Affiliations

¹ Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
² Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
³ Center for Healthcare Organization and Implementation Research, Boston Veterans Affairs Healthcare System, Boston, Massachusetts.
⁴ Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
⁵ Veterans Affairs Health Services Research & Development Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.
⁶ Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
⁷ Division of Geriatrics, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California.

PMID: 28493543
PMCID: PMC5589505
DOI: 10.1002/cncr.30765

Item in Clipboard

Abstract

Background: Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening.

Methods: In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression.

Results: Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening).

Conclusions: In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA.

Keywords: colonoscopy; colorectal neoplasms; diagnostic services; early detection of cancer; health services accessibility; mass screening; veterans health.

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Conflict of interest statement

Potential competing interests: None

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Figure 2

Multivariate and sensitivity-adjusted colonoscopy completion…

Figure 2

Multivariate and sensitivity-adjusted colonoscopy completion rates by race/ethnicity

Figure 2

Multivariate and sensitivity-adjusted colonoscopy completion rates by race/ethnicity

Figure 3

Multivariate and sensitivity-adjusted colonoscopy completion…

Figure 3

Multivariate and sensitivity-adjusted colonoscopy completion rates by age

Figure 3

Multivariate and sensitivity-adjusted colonoscopy completion rates by age

Figure 4

Multivariate and sensitivity-adjusted colonoscopy completion…

Figure 4

Multivariate and sensitivity-adjusted colonoscopy completion rates by Charlson score

Figure 4

Multivariate and sensitivity-adjusted colonoscopy completion rates by Charlson score