Timely follow-up of positive fecal occult blood tests strategies associated with improvement

• Published in: American journal of preventive medicine 2009-08, Vol.37 (2), p.87-93
• Main Authors: Powell, Adam A, Gravely, Amy A, Ordin, Diana L, Schlosser, James E, Partin, Melissa R
• Format: Article
• Language: English
• Subjects: Blood tests; Colonoscopy - methods; Colorectal cancer; Colorectal Neoplasms - diagnosis; Data Collection; Delivery of Health Care - standards; Follow-Up Studies; Hospitals, Veterans - organization & administration; Hospitals, Veterans - standards; Humans; Infrastructure; Mass Screening - methods; Occult; Occult Blood; Patient care; Quality Assurance, Health Care - organization & administration; Screening; Time Factors; United States; United States Department of Veterans Affairs
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2009.05.013

In light of previous research indicating that many patients fail to receive timely diagnostic follow-up of positive colorectal cancer (CRC) screening tests, the Veterans Health Administration (VA) initiated a national CRC diagnosis quality-improvement (QI) effort. This article documents the percent of patients receiving follow-up within 60 days of a positive CRC screening fecal occult blood test (FOBT) and identifies improvement strategies that predict timely follow-up. In 2007, VA facilities completed a survey in which they indicated the degree to which they had implemented a series of improvement strategies and described barriers to improvement. Three types of strategies were assessed: developing QI infrastructure, improving care delivery processes, and building gastroenterology capacity. Survey data were merged with a measure of 60-day positive-FOBT follow-up. Facility-level predictors of timely follow-up were identified and relationships among categories of improvement strategies were assessed. Data were analyzed in 2008. The median facility-reported 60-day follow-up rate for positive screening FOBTs was 24.5%. Several strategies were associated with timeliness of follow-up. The relationship between the implementation of QI infrastructure strategies and timely follow-up was mediated by the implementation of process-change strategies. Although constraints on gastroenterology capacity were often sited as a key barrier, implementation of strategies to address this issue was unassociated with timely follow-up. Developing QI infrastructure appears to be an effective strategy for improving FOBT follow-up when this work is followed by process improvements. Increasing gastroenterology capacity may be more difficult than improving processes of care.