Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization Journal Article


Authors: Miglioretti, D. L.; Rutter, C. M.; Bradford, S. C.; Zauber, A. G.; Kessler, L. G.; Feuer, E. J.; Grossman, D. C.
Article Title: 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 (ie, colonoscopy or flexible sigmoidoscopy with double contrast barium enema) and treatment. OBJECTIVES: To examine whether rates of complete diagnostic evaluation after 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 1 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 1 year increased from 57-64% in 1993-1996 to 82-86% from 2000-2005. Use of repeat FOBT after 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 in 2000-2005 were followed by complete diagnostic evaluation nationally. CONCLUSIONS: Adherence to recommendations for complete diagnostic evaluation after 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.
Keywords: aged; middle aged; retrospective studies; united states; clinical practice; organization and management; physician's practice patterns; statistics; mass screening; practice guideline; retrospective study; colorectal neoplasms; utilization review; chemistry; doctor patient relation; diagnostic agent; colonoscopy; colorectal tumor; physician-patient relations; diagnostic test; guideline adherence; feces; sigmoidoscopy; occult blood; primary health care; diagnostic tests, routine; delivery of health care, integrated; barium sulfate; integrated health care system
Journal Title: Medical Care
Volume: 46
Issue: 9 Suppl 1
ISSN: 0025-7079
Publisher: Lippincott Williams & Wilkins  
Date Published: 2008-09-01
Start Page: S91
End Page: S96
Language: English
PUBMED: 18725839
PROVIDER: scopus
PMCID: PMC4227983
DOI: 10.1097/MLR.0b013e31817946c8
DOI/URL:
Notes: --- - "Cited By (since 1996): 10" - "Export Date: 7 June 2012" - "Source: Scopus"
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  1. Ann G Zauber
    282 Zauber