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Showing content from https://pubmed.ncbi.nlm.nih.gov/30829917/ below:

Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study

doi: 10.14309/ctg.0000000000000010. Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study

Affiliations

¹ Kaiser Permanente Division of Research, Oakland, California, USA.
² Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
³ One Medical, San Francisco, California, USA.
⁴ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
⁵ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
⁶ Kaiser Permanente Medical Offices, Walnut Creek, California, USA.

PMID: 30829917
PMCID: PMC6407828
DOI: 10.14309/ctg.0000000000000010

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Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study

Kevin Selby et al. Clin Transl Gastroenterol. 2019 Feb.

doi: 10.14309/ctg.0000000000000010. Affiliations

¹ Kaiser Permanente Division of Research, Oakland, California, USA.
² Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
³ One Medical, San Francisco, California, USA.
⁴ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
⁵ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
⁶ Kaiser Permanente Medical Offices, Walnut Creek, California, USA.

PMID: 30829917
PMCID: PMC6407828
DOI: 10.14309/ctg.0000000000000010

Item in Clipboard

Abstract

Objectives: The effectiveness of fecal immunochemical test (FIT) screening for colorectal cancer depends on timely colonoscopy follow-up of positive tests, although limited data exist regarding effective system-level strategies for improving follow-up rates.

Methods: Using a mixed-methods design (qualitative and quantitative), we first identified system-level strategies that were implemented for improving timely follow-up after a positive FIT test in a large community-based setting between 2006 and 2016. We then evaluated changes in time to colonoscopy among FIT-positive patients across 3 periods during the study interval, controlling for screening participant age, sex, race/ethnicity, comorbidity, FIT date, and previous screening history.

Results: Implemented strategies over the study period included setting a goal of colonoscopy follow-up within 30 days of a positive FIT, tracking FIT-positive patients, early telephone contact to directly schedule follow-up colonoscopies, assigning the responsibility for follow-up tracking and scheduling to gastroenterology departments (vs primary care), and increasing colonoscopy capacity. Among 160,051 patients who had a positive FIT between 2006 and 2016, 126,420 (79%) had a follow-up colonoscopy within 180 days, including 67% in 2006-2008, 79% in 2009-2012, and 83% in 2013-2016 (P < 0.001). Follow-up within 180 days in 2016 varied moderately across service areas, between 72% (95% CI 70-75) and 88% (95% CI 86-91), but there were no obvious differences in the pattern of strategies implemented in higher- vs lower-performing service areas.

Conclusions: The implementation of system-level strategies coincided with substantial improvements in timely colonoscopy follow-up after a positive FIT. Intervention studies are needed to identify the most effective strategies for promoting timely follow-up.

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Figures
Figure 1.

Organization of follow-up of participants…

Figure 1.

Organization of follow-up of participants with positive FITs. Color coding reflects the period…

Figure 1.

Organization of follow-up of participants with positive FITs. Color coding reflects the period when elements were implemented. FIT, fecal immunochemical test; MA, medical assistant; NP, nurse practitioner; PA, physician assistant; PROMPT, patient reminder, outreach management, patient tracking system.

Figure 2.

Time to colonoscopy after a…

Figure 2.

Time to colonoscopy after a positive fecal immunochemical test among all screening participants…

Figure 2.

Time to colonoscopy after a positive fecal immunochemical test among all screening participants from Kaiser Permanente Northern California, stratified by period. Curves created using a Cox proportional hazard model of the time to colonoscopy, adjusting for patient characteristics.