BACKGROUND/RATIONALE:
The recommended interval for the next colonoscopy is based on the endoscopic and pathologic findings of the initial colonoscopy. These intervals range from 3 to 10 years. Studies report that physicians in the community setting recommend repeat colonoscopies sooner than recommended by published guidelines. Adherence to colonoscopy guidelines in the VA healthcare system is unknown. Physician recommendations of procedures are a key factor in health care utilization. Therefore, recommendations for colonoscopies that exceed guidelines may lead to overuse. Overuse of colonoscopy is expensive, reduces the capacity to perform initial screening or diagnostic colonoscopies, and places veterans at unjustified risk.


OBJECTIVE(S):
The overall goal of this study is to determine if VA physicians follow published guidelines in their recommendations for when colonoscopy should be repeated and to identify productive targets for modifying provider behavior.

AIM1 Document the current patterns of repeat colonoscopy recommendation in the VA healthcare system with respect to findings at index colonoscopy and to compare provider recommendations for repeat colonoscopies to the published multi-society guidelines

AIM2 Identify patient, physician, and organizational factors associated with any departure from guidelines

METHODS:
Data abstracted from the VA electronic medical record (VistAWeb), VA administrative claims, and physician databases will be analyzed in a national sample of VA patients, aged 50-64 years, who have recently undergone colonoscopy and have had no prior colonoscopies for at least 10 years. First 25 facilities which perform at least 500 outpatient colonoscopies per year will be randomly selected among 16 combinations of geographic region (4 regions), academic affilation (yes or no), and complexity score (high complexity or medium/low complexity) in the proportion in which combination occurs in the entire VA. For each facility, 100 patients will be randomly selected with over selection of women and minority veterans. VA data pertaining to the patient and the colonoscopy will be merged with physician data from the AMA Masterfile. We will estimate the proportion of colonoscopies for which the endoscopist followed guidelines in recommending the interval until the next colonoscopy. Logistic regression modeling, with evaluation of clustering, will be used to assess predictors of guideline adherence.


FINDINGS/RESULTS:
Not yet available.

IMPACT:
At least half of veterans aged 50 years and older report having undergone colonoscopy in the last 10 years and over 140,000 colonoscopies are performed in the VA annually. Published guidelines address the timing of the repeat colonoscopy based on the results of the initial colonoscopy. Evaluation of physician recommendations for repeat colonoscopies is needed to identify colonoscopy patterns of VA physicians and barriers to guideline-concordance that can be addressed in future intervention studies.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Shah T, Grambow SC, Johnson MR, Provenzale D, Maciejewski ML, Fisher DA. Adequacy of Bowel Preparation and Documentation of Bowel Preparation Quality at Index Colonoscopy in the VA Health Care System. Gastroenterology. 2012 May 1; 142(5):S-225-S-226. [view]
2. Wachter, Fisher. Adherence to polyp surveillance guidelines at an academic VA Medical Center. The American journal of gastroenterology. 2007 Nov 1; 102((S2)):1198. [view]
3. ASGE Standards of Practice Committee, Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD. Adverse events of upper GI endoscopy. Gastrointestinal endoscopy. 2012 Oct 1; 76(4):707-18. [view]
4. Fisher DA, Grubber JM, Castor JM, Coffman CJ. Ascertainment of colonoscopy indication using administrative data. Digestive diseases and sciences. 2010 Jun 1; 55(6):1721-5. [view]
5. Patwardhan M, Fisher DA, Mantyh CR, McCrory DC, Morse MA, Prosnitz RG, Cline K, Samsa GP. Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature). Journal of evaluation in clinical practice. 2007 Dec 1; 13(6):831-45. [view]
6. De Ceglie A, Fisher DA, Filiberti R, Blanchi S, Conio M. Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: the role of diet. Clinics and research in hepatology and gastroenterology. 2011 Jan 1; 35(1):7-16. [view]
7. Fisher DA, Jeffreys A, Coffman CJ, Fasanella K. Barriers to full colon evaluation for a positive fecal occult blood test. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2006 Jun 1; 15(6):1232-5. [view]
8. Patwardhan MB, Samsa GP, McCrory DC, Fisher DA, Mantyh CR, Morse MA, Prosnitz RG, Cline KE, Gray RN. Cancer care quality measures: diagnosis and treatment of colorectal cancer. Evidence Report/Technology Assessment. 2006 May 1;(138):1-116. [view]
9. Conio M, Blanchi S, Repici A, Ruggeri C, Fisher DA, Filiberti R. Cap-assisted endoscopic mucosal resection for colorectal polyps. Diseases of The Colon and Rectum. 2010 Jun 1; 53(6):919-27. [view]
10. Conio M, Blanchi S, Filiberti R, Ruggeri C, Fisher DA. Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve. Endoscopy. 2010 Aug 1; 42(8):677-80. [view]
11. Garman KS, Jeffreys A, Coffman C, Fisher DA. Colorectal cancer screening, comorbidity, and follow-up in elderly patients. The American journal of the medical sciences. 2006 Oct 1; 332(4):159-63. [view]
12. Long MD, Lance T, Robertson D, Kahwati L, Kinsinger L, Fisher DA. Colorectal cancer testing in the national Veterans Health Administration. Digestive diseases and sciences. 2012 Feb 1; 57(2):288-93. [view]
13. ASGE Standards of Practice Committee, Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointestinal endoscopy. 2011 Oct 1; 74(4):745-52. [view]
14. ASGE Standards of Practice Committee, Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA. Complications of ERCP. Gastrointestinal endoscopy. 2012 Mar 1; 75(3):467-73. [view]
15. Fisher DA, Zullig LL, Grambow SC, Abbott DH, Sandler RS, Fletcher RH, El-Serag HB, Provenzale D. Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System. Digestive diseases and sciences. 2010 May 1; 55(5):1434-41. [view]
16. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012 Mar 14; 307(10):1072-9. [view]
17. Fisher DA, Grubber J, Grambow SC, Johnson MR. Factors Associated With Non-Adherence to Colonoscopy Interval Guidelines in an Integrated Managed Care System. Gastroenterology. 2012 May 1; 142(5):S-80. [view]
18. Balmadrid BL, Thomas CM, Coffman CJ, Liddle RA, Fisher DA. Factors associated with survival of veterans with gastrointestinal neuroendocrine tumors. Journal of cancer epidemiology. 2012 May 27; 2012:986708. [view]
19. Fisher A, Johnson R, Chaheen J. Fecal Occult Blood Testing Completion in a VA Population: Low and Strongly Related to Race. Journal of clinical outcomes management : JCOM. 2007 Apr 1; 14(2):93-101. [view]
20. ASGE Standard of Practice Committee, Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Evans JA, Early DS, Fanelli RD, Fisher DA, Foley KQ, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Pasha SF, Sharaf RN, Dominitz JA, Cash BD. Guidelines for endoscopy in pregnant and lactating women. Gastrointestinal endoscopy. 2012 Jul 1; 76(1):18-24. [view]
21. De Ceglie A, Filiberti R, Blanchi S, Fontana V, Fisher DA, Grossi E, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Casa DD, Foti M, Laterza F, Rosati R, Annese V, Iaquinto G, Conio M. History of cancer in first degree relatives of Barrett's esophagus patients: a case-control study. Clinics and research in hepatology and gastroenterology. 2011 Dec 1; 35(12):831-8. [view]
22. Fisher DA, Galanko J, Dudley TK, Shaheen NJ. Impact of comorbidity on colorectal cancer screening in the veterans healthcare system. Clinical Gastroenterology and Hepatology. 2007 Aug 1; 5(8):991-6. [view]
23. Fisher DA, Judd L, Sanford NS. Inappropriate colorectal cancer screening: findings and implications. The American journal of gastroenterology. 2005 Nov 1; 100(11):2526-30. [view]
24. Partin MR, Powell AA, Bangerter A, Halek K, Burgess JF, Fisher DA, Nelson DB. Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration. Journal of general internal medicine. 2012 Dec 1; 27(12):1618-25. [view]
25. Gellad ZF, Stechuchak KM, Fisher DA, Olsen MK, McDuffie JR, Ostbye T, Yancy WS. Longitudinal adherence to fecal occult blood testing impacts colorectal cancer screening quality. The American journal of gastroenterology. 2011 Jun 1; 106(6):1125-34. [view]
26. Fisher DA, Johnson MR, Shaheen NJ. Mail return of fecal occult blood testing is low in a VA population and strongly related to race: A retrospective study. Journal of clinical outcomes management : JCOM. 2007 Feb 1; 14(2):93-98. [view]
27. Yancy WS, McDuffie JR, Stechuchak KM, Olsen MK, Oddone EZ, Kinsinger LS, Datta SK, Fisher DA, Krause KM, Østbye T. Obesity and receipt of clinical preventive services in veterans. Obesity (Silver Spring). 2010 Sep 1; 18(9):1827-35. [view]
28. Burgess DJ, van Ryn M, Grill J, Noorbaloochi S, Griffin JM, Ricards J, Vernon SW, Fisher DA, Partin MR. Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines. Journal of general internal medicine. 2011 Mar 1; 26(3):251-8. [view]
29. Prosnitz RG, Patwardhan MB, Samsa GP, Mantyh CR, Fisher DA, McCrory DC, Cline KE, Gray RN, Morse MA. Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review. Cancer. 2006 Nov 15; 107(10):2352-60. [view]
30. Palmer LB, Abbott DH, Hamilton N, Provenzale D, Fisher DA. Quality of colonoscopy reporting in community practice. Gastrointestinal endoscopy. 2010 Aug 1; 72(2):321-7, 327.e1. [view]
31. Partin MR, Burgess DJ, Halek K, Grill J, Vernon SW, Fisher DA, Griffin JM, Murdoch M. Randomized trial showed requesting medical records with a survey produced a more representative sample than requesting separately. Journal of clinical epidemiology. 2008 Oct 1; 61(10):1028-35. [view]
32. Fisher A, Vernon, Halek, Grill, Noorbaloochi. Self-reported colorectal cancer screening status: An accurate option for practice and research. Gastroenterology. 2007 Jun 1; 132(4):suppl: A472. [view]
33. Fisher DA, Yancy WS, Galanko J, Martin C, Sandler RS. The impact of obesity on colon cancer screening. Gastroenterology. 2007 Jul 1; 132(4):suppl:A148. [view]
34. Partin MR, Noorbaloochi S, Grill J, Burgess DJ, van Ryn M, Fisher DA, Griffin JM, Powell AA, Halek K, Bangerter A, Vernon SW. The interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer screening adherence. Cancer Causes & Control : Ccc. 2010 Sep 1; 21(9):1357-68. [view]
35. Hwang JH, Fisher DA, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Early DS, Evans JA, Fanelli RD, Foley K, Fukami N, Jain R, Jue TL, Khan KM, Lightdale J, Malpas PM, Maple JT, Pasha S, Saltzman J, Sharaf R, Shergill AK, Dominitz JA, Cash BD, Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointestinal endoscopy. 2012 Jun 1; 75(6):1132-8. [view]
36. ASGE Standards of Practice Committee, Maple JT, Ikenberry SO, Anderson MA, Appalaneni V, Decker GA, Early D, Evans JA, Fanelli RD, Fisher D, Fisher L, Fukami N, Hwang JH, Jain R, Jue T, Khan K, Krinsky ML, Malpas P, Ben-Menachem T, Sharaf RN, Dominitz JA. The role of endoscopy in the management of choledocholithiasis. Gastrointestinal endoscopy. 2011 Oct 1; 74(4):731-44. [view]
37. Gellad, Almirall, Provenzale, Fisher. Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia. Gastroenterology. 2008 May 1; 134(4):A151. [view]
38. Gellad ZF, Almirall D, Provenzale D, Fisher DA. Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia. Digestive diseases and sciences. 2009 Nov 1; 54(11):2497-502. [view]
39. Fisher, Zullig, Grambow, Abbott, Provenzale. Time to diagnosis of colorectal cancer in the VA system. Gastroenterology. 2008 May 1; 134(4):A152. [view]
40. Fisher DA, Voils CI, Coffman CJ, Grubber JM, Dudley TK, Vernon SW, Bond JH, Provenzale D. Validation of a questionnaire to assess self-reported colorectal cancer screening status using face-to-face administration. Digestive diseases and sciences. 2009 Jun 1; 54(6):1297-306. [view]
41. Partin MR, Grill J, Noorbaloochi S, Powell AA, Burgess DJ, Vernon SW, Halek K, Griffin JM, van Ryn M, Fisher DA. Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2008 Apr 1; 17(4):768-76. [view]
42. Srygley FD, Abbott DH, Grambow SC, Provenzale D, Sandler RS, Fischer DA. Variability in resource use: diagnosing colorectal cancer. The American journal of managed care. 2013 May 1; 19(5):370-6. [view]
43. Salz T, Weinberger M, Ayanian JZ, Brewer NT, Earle CC, Elston Lafata J, Fisher DA, Weiner BJ, Sandler RS. Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States. BMC health services research. 2010 Sep 1; 10:256. [view]
44. Fisher DA. Watchful waiting after endoscopic removal of common bile duct stones: cheaper and better? The American journal of gastroenterology. 2006 Apr 1; 101(4):753-4. [view]

Journal Other

1. Fisher DA. Calling a spade a spade--are we biased against "normal"? [Editorial]. The American journal of gastroenterology. 2007 Aug 1; 102(8):1588-9. [view]
2. Fisher DA. Electronic medical records and improving the quality of the screening process. [Editorial]. Journal of general internal medicine. 2011 Jul 1; 26(7):683-4. [view]
3. Fisher DA. Noninvasive Tests for Colorectal Cancer Screening. [Editorial]. Gastroenterology. 2009 Apr 1; 5:315-319. [view]
4. Jou JH, Fisher DA. Predictive algorithms: uses and limitations. [Editorial]. Digestive diseases and sciences. 2010 Nov 1; 55(11):3016-7. [view]

Magazine/Popular Press Articles

1. Pollack A, Fisher DA. Noninvasive Cancer Test Is Effective, Study Finds. Business Day. 2013 Apr 18; 1(1):1. [view]

Conference Presentations

1. Fisher DA. Barriers to colon cancer screening programs and strategies. Paper presented at: North Carolina Society of Gastroenterology Annual Meeting; 2009 Feb 8; Pinehurst, NC. [view]
2. Fisher DA. Colorectal Cancer Screening & Surveillance: Underuse. Paper presented at: University of Washington Frontiers in Gastroenterology and Hepatology Annual Series; 2010 Sep 17; Seattle, WA. [view]
3. Fisher DA. Colorectal Cancer Screening Update, Endoscopy in Gastrointestinal Oncology. Paper presented at: European School of Oncology Endoscopy in Gastrointestinal Oncology Biennial Seminar; 2011 Mar 11; Rome, Italy. [view]
4. Fisher DA, Galanko J, Dudley T, Shaheen AW. Comorbidity and colorectal cancer screening utilization in a national sample of VHA patients. Paper presented at: Gastrointestinal Cancers Annual Symposium; 2006 May 1; San Francisco, CA. [view]
5. Fisher DA. Controversies and Considerations fro Colorectal Cancer Screening and Surveillance. Paper presented at: Pri-Med Access with American College of Physicians Quarterly Seminar; 2010 Apr 17; Atlanta, GA. [view]
6. Fisher DA. Determinants of Time to Diagnosis of Colorectal Cancer in the VA System. Paper presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD. [view]
7. Fisher DA. Does Colonoscopy Work? Paper presented at: Arkansas-Oklahoma Endoscopic Society Annual Meeting; 2011 Jun 18; Dallas, TX. [view]
8. Smith AD, Fisher DA. Hemochromatosis is associated with increased colorectal cancer prevalence in a national sample of US veterans: case-control study. Paper presented at: VA VISN 23 Chronic Disease Management Collaborative; 2006 Apr 1; Minneapolis, MN. [view]
9. Gellad ZF, Yancy WS, Fisher DA. Low Adherence to Fecal Occult Blood Testing Over Time: Why Cross-sectional Performance Measures May Overestimate Colorectal Cancer Screening Rates. Paper presented at: Digestive Disease Week Annual Meeting; 2010 May 15; New Orleans, LA. [view]
10. Fisher DA. Medical Record Validation of the National Cancer Institute's Colorectal Cancer Screening Status Questionnaire. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD. [view]
11. Yancy WS, McDuffie J, Stechuchak KM, Olsen MK, Datta SK, Fisher DA, Oddone EZ. Obesity is not associated with lower receipt of Clinical Preventive Services in Veterans. Paper presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD. [view]
12. Fisher DA. Post-polypectomy surveillance. Paper presented at: European School of Oncology Endoscopy in Gastrointestinal Oncology Biennial Seminar; 2011 Mar 11; Rome, Italy. [view]
13. Fisher DA, Coffman CJ. Race and Screening Colonoscopy in the VA System. Poster session presented at: Gastroenterology Research Group Research Methodology Annual Meeting; 2009 May 1; Washington, DC. [view]
14. Yancy WS, McDuffie J, Stechuchak KM, Olsen MK, Datta SK, Fisher DA, Oddone EZ. Relationship between obesity and receipt of clinical preventive services in Veterans. Poster session presented at: Obesity Society Annual Scientific Meeting; 2008 Oct 5; Phoenix, AZ. [view]
15. Gellad Z, Fisher DA, Provenzale D. Time to colonoscopy from positive fecal occult blood test and findings on colonoscopy. Paper presented at: VA HSR&D National Meeting; 2008 Feb 14; Baltimore, MD. [view]
16. Partin MR, Grill J, Halek K, Vernon S, Noorbaloochi S, Powell AA, Griffin JM, Burgess D, van Ryn M, Fisher DA. Validation of Self-Reported Colorectal Cancer Screening Behavior Data Collected from a Mixed-mode Survey of Veterans. Paper presented at: VA HSR&D National Meeting; 2008 Feb 14; Baltimore, MD. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems, Cancer, Digestive Diseases
DRE: Diagnosis, Prevention, Prognosis
Keywords: Cancer
MeSH Terms: none