Organizational Predictors of Colonoscopy Follow-up for Positive Fecal Occult Blood Test Results: An Observational Study
Organizational Predictors of Colonoscopy Follow-up for Positive Fecal Occult Blood Test Results: An Observational Study
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DOI：
10.1158/1055-9965.epi-14-1170
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发表时间：
2015-02-01
影响因子：
3.8
通讯作者：
Nelson, David B.
中科院分区：
文献类型：
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作者：
Partin, Melissa R.;Burgess, Diana J.;Nelson, David B.
背景资料：本研究评估了从设施调查中确定的组织结构和流程对随访阳性粪便潜血试验[FOBT阳性（FOBT+）]的贡献。我们在2009年8月16日至2011年3月20日期间从98家退伍军人健康管理局（VHA）机构中确定了74，104例FOBT+结果的患者，并对其进行了随访，直至9月30日。2011年，完成结肠镜检查。我们从VHA行政记录中确定了患者特征，并从初级保健和胃肠病学负责人完成的机构调查中确定了组织因素。我们估计预测结肠镜检查完成60天和6个月内使用分层logistic回归models.Results：30%的患者FOBT+结果在60天内和49%在6个月内接受结肠镜检查。胃肠病学或实验室工作人员直接通知胃肠病学提供者FOBT+病例是60天[比值比（OR），1.85; P = 0.01]和6个月随访（OR，1.25; P = 0.008）的重要预测因素。60天随访的其他预测因素包括结肠镜检查预约的充分性（OR，1.43; P = 0.01）和向初级保健提供者频繁反馈FOBT+转诊及时性（OR，1.79; P = 0.04）。6个月随访的其他预测因素包括使用指南一致的低风险腺瘤监测间隔（OR，1.57; P = 0.01）和使用小组预约和联合口头书面方法进行结肠镜检查准备指导（OR，1.48; P = 0.0001）。使用指南一致的腺瘤监测间隔，直接通知胃肠病学提供者FOBT+结果，使用提供口头和书面信息的结肠镜检查准备指导方法可能会增加总体随访率。在60天内加强随访可能需要增加结肠镜检查能力和反馈给初级保健providers.Impact：这些发现可能会告知组织层面的干预措施，以改善FOBT+随访。（C）2014年AACR。
Background: This study assessed the contribution of organizational structures and processes identified from facility surveys to follow-up for positive fecal occult blood tests [FOBT-positive (FOBT+)].Methods: We identified 74,104 patients with FOBT+ results from 98 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011, and followed them until September 30, 2011, for completion of colonoscopy. We identified patient characteristics from VHA administrative records, and organizational factors from facility surveys completed by primary care and gastroenterology chiefs. We estimated predictors of colonoscopy completion within 60 days and six months using hierarchical logistic regression models.Results: Thirty percent of patients with FOBT+ results received colonoscopy within 60 days and 49% within six months. Having gastroenterology or laboratory staff notify gastroenterology providers directly about FOBT+ cases was a significant predictor of 60-day [odds ratio (OR), 1.85; P = 0.01] and six-month follow-up (OR, 1.25; P = 0.008). Additional predictors of 60-day follow-up included adequacy of colonoscopy appointment availability (OR, 1.43; P = 0.01) and frequent individual feedback to primary care providers about FOBT+ referral timeliness (OR, 1.79; P = 0.04). Additional predictors of six-month follow-up included using guideline-concordant surveillance intervals for low-risk adenomas (OR, 1.57; P = 0.01) and using group appointments and combined verbal-written methods for colonoscopy preparation instruction (OR, 1.48; P = 0.0001).Conclusion: Directly notifying gastroenterology providers about FOBT+ results, using guideline-concordant adenoma surveillance intervals, and using colonoscopy preparations instruction methods that provide both verbal and written information may increase overall follow-up rates. Enhancing follow-up within 60 days may require increased colonoscopy capacity and feedback to primary care providers.Impact: These findings may inform organizational-level interventions to improve FOBT+ follow-up. (C)2014 AACR.