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

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License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_3A59A41398A8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study.
Journal
Clinical and translational gastroenterology
Author(s)
Selby K., Jensen C.D., Zhao W.K., Lee J.K., Slam A., Schottinger J.E., Bacchetti P., Levin T.R., Corley D.A.
ISSN
2155-384X (Electronic)
ISSN-L
2155-384X
Publication state
Published
Issued date
02/2019
Peer-reviewed
Oui
Volume
10
Number
2
Pages
e00010
Language
english
Notes
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
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.
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.
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.
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.
Keywords
Aftercare/organization & administration, Aged, Colonoscopy/statistics & numerical data, Colorectal Neoplasms/diagnosis, Comorbidity, Early Detection of Cancer/methods, Early Detection of Cancer/statistics & numerical data, Female, Gastroenterologists/organization & administration, Humans, Male, Mass Screening/organization & administration, Middle Aged, Occult Blood, Patient Acceptance of Health Care/psychology, Patient Acceptance of Health Care/statistics & numerical data, Primary Health Care/organization & administration, Program Evaluation, Qualitative Research, Retrospective Studies
Pubmed
Web of science
Open Access
Yes
Create date
07/04/2019 14:17
Last modification date
03/05/2020 6:02
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