Electronic Record Intervention Improves Follow-Up of Veterans with Positive Colorectal Cancer Screening
BACKGROUND:
Fecal occult blood test (FOBT) screening programs have shown colorectal cancer (CRC) mortality reductions of 15% to 33%, as well as significant reductions in CRC incidence. Moreover, mortality rates have been declining for the last several years, and this is believed due partly to increased screening. However, nationally, only one in three individuals with positive FOBTs undergoes colonoscopy. This randomized trial of eight VAMCs evaluated an electronic record intervention for follow-up of Veterans with a positive FOBT. In the intervention sites, an electronic consult that imported relevant clinical information was automatically submitted to the gastroenterology (GI) clinic for all Veterans with a positive FOBT at the time the result was recorded in the lab. Centers randomized as control sites received no intervention and any necessary patient follow-up was initiated by their PCP; in all sites, primary care physicians continued to be notified of positive FOBT results in the usual manner. Investigators compared changes in the proportion of Veterans with a positive FOBT who had a GI consult, or a GI consult plus complete diagnostic evaluation (CDE) of the colon within 30, 90, and 180 days – across intervention and control sites.
FINDINGS:
- A simple electronic intervention that involved an automatic GI consult for Veterans with a positive FOBT result improved follow-up and reduced the time between a positive FOBT and GI evaluation, as well as complete diagnostic evaluation (CDE).
- The 30, 90, and 180 day GI consult rates improved 21% to 33% among intervention sites, but did not change in the usual care sites. Thirty, 90, and 180 day CDE rates improved 9% to 31% in intervention sites, but did not significantly change in usual care sites.
- Time to GI consult and CDE decreased significantly over time in the intervention sites, but remained unchanged in the usual care sites.
LIMITATIONS:
- Due to programming limitations, investigators were unable to evaluate exactly what sort of diagnostic evaluation Veterans received, although they were able to date such procedures. Investigators then made an assumption that once the patient’s consult was reviewed by GI, the patient’s care would be appropriate.
AUTHOR/FUNDING INFORMATION:
This study was partly funded through HSR&D (CRT 02-059). Dr. Humphrey is part of HSR&D’s Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders. Dr. Partin is part of HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis, MN.
Humphrey L, Shannon J, Partin M, et al. Improving the Follow-up of Positive Hemoccult Screening Tests: An Electronic Intervention. Journal of General Internal Medicine February 15, 2011;e-pub ahead of print.
