Development of a multivariable prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test in community clinics.
Development of a multivariable prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test in community clinics.
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DOI：
10.1186/s12913-020-05883-2
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发表时间：
2020-11-10
影响因子：
2.8
通讯作者：
Coronado GD
中科院分区：
文献类型：
--
作者：
Petrik AF;Keast E;Johnson ES;Smith DH;Coronado GD
结直肠癌（CRC）是美国男性和女性中的第三大癌症杀手。在重点人群中停止结肠癌的策略和机会（STOP CRC）项目旨在通过邮寄粪便免疫化学测试（FIT）外展计划，增加联邦合格卫生中心（BHCs）患者的CRC筛查。然而，在异常FIT后完成随访结肠镜检查的比率仍然很低。我们开发了一个多变量预测模型，使用电子健康记录中的数据来评估患者在异常FIT测试后获得结肠镜检查的概率。为了评估获得结肠镜检查的可能性，我们使用考克斯回归在FIT结果异常的回顾性队列患者中建立风险预测模型。在1596例FIT结果异常的患者中，556例（34.8%）在6个月内进行了结肠镜检查。该模型显示了患者在不依从随访结肠镜检查的风险水平之间的充分分离（Bootstrap校正的C统计量> 0.63）。改进的模型包括8个变量：年龄，种族，保险，GINI收入不平等，长期抗凝剂使用，过去一年接受流感疫苗，错过诊所预约的频率和诊所地点。在6个月内获得随访结肠镜检查的概率在五分位数之间存在差异;最低五分位数的患者估计有18%的机会，而最高五分位数的患者有超过55%的机会获得随访结肠镜检查。了解谁不太可能对异常的FIT测试进行随访，可以帮助确定需要早期干预以完成随访结肠镜检查的患者。本试验于2012年12月5日在ClinicalTrials.gov（NCT 01742065）上注册。协议可用。在线版本包含补充材料，可通过10.1186/s12913-020-05883-2获得。
Colorectal cancer (CRC) is the 3rd leading cancer killer among men and women in the US. The Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project aimed to increase CRC screening among patients in Federally Qualified Health Centers (FQHCs) through a mailed fecal immunochemical test (FIT) outreach program. However, rates of completion of the follow-up colonoscopy following an abnormal FIT remain low. We developed a multivariable prediction model using data available in the electronic health record to assess the probability of patients obtaining a colonoscopy following an abnormal FIT test. To assess the probability of obtaining a colonoscopy, we used Cox regression to develop a risk prediction model among a retrospective cohort of patients with an abnormal FIT result. Of 1596 patients with an abnormal FIT result, 556 (34.8%) had a recorded colonoscopy within 6 months. The model shows an adequate separation of patients across risk levels for non-adherence to follow-up colonoscopy (bootstrap-corrected C-statistic > 0.63). The refined model included 8 variables: age, race, insurance, GINI income inequality, long-term anticoagulant use, receipt of a flu vaccine in the past year, frequency of missed clinic appointments, and clinic site. The probability of obtaining a follow-up colonoscopy within 6 months varied across quintiles; patients in the lowest quintile had an estimated 18% chance, whereas patients in the top quintile had a greater than 55% chance of obtaining a follow-up colonoscopy. Knowing who is unlikely to follow-up on an abnormal FIT test could help identify patients who need an early intervention aimed at completing a follow-up colonoscopy. This trial was registered at ClinicalTrials.gov (NCT01742065) on December 5, 2012. The protocol is available. The online version contains supplementary material available at 10.1186/s12913-020-05883-2.
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DOI：
10.1001/jama.2017.11389
发表时间：
2017-09-05
期刊：
JAMA
影响因子：
--
作者：
Singal AG;Gupta S;Skinner CS;Ahn C;Santini NO;Agrawal D;Mayorga CA;Murphy C;Tiro JA;McCallister K;Sanders JM;Bishop WP;Loewen AC;Halm EA
通讯作者：
Halm EA
DOI：
10.1158/1055-9965.epi-15-0470
发表时间：
2016-02
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Chubak J;Garcia MP;Burnett-Hartman AN;Zheng Y;Corley DA;Halm EA;Singal AG;Klabunde CN;Doubeni CA;Kamineni A;Levin TR;Schottinger JE;Green BB;Quinn VP;Rutter CM;PROSPR consortium
通讯作者：
PROSPR consortium
影响因子：
39.2
作者：
Collins, Gary S.;Reitsma, Johannes B.;Moons, Karel G. M.
通讯作者：
Moons, Karel G. M.
影响因子：
2.2
作者：
Coronado, Gloria D.;Vollmer, William M.;Green, Beverly B.
通讯作者：
Green, Beverly B.
影响因子：
5.7
作者：
Jetelina, Katelyn K.;Yudkin, Joshua S.;Balasubramanian, Bijal A.
通讯作者：
Balasubramanian, Bijal A.