Colonoscopy Following an Abnormal Fecal Test Result from an Annual Colorectal Cancer Screening Program in a Federally Qualified Health Center.
Colonoscopy Following an Abnormal Fecal Test Result from an Annual Colorectal Cancer Screening Program in a Federally Qualified Health Center.
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DOI：
10.1177/21501319221138423
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发表时间：
2022-01
影响因子：
3.6
通讯作者：
Coronado, Gloria. D. D.
中科院分区：
文献类型：
--
作者：
Escaron, Anne. L. L.;Garcia, Joanna;Petrik, Amanda. F. F.;Ruiz, Esmeralda;Nyongesa, Denis. B. B.;Thompson, Jamie. H. H.;Coronado, Gloria. D. D.
关键词：
粪便免疫化学测试（FIT）结果异常的个体患结直肠癌的风险升高，如果延迟结肠镜检查的随访，风险会增加。值得注意的是，在联邦合格的医疗中心（FQHCs），美国医疗机构服务于大多数种族和少数民族患者群体的随访结肠镜检查率低得惊人。我们评估了异常FIT结果后结肠镜检查的相关因素，并使用图表抽象数据来评估缺乏随访的原因（包括过程措施），作为大型拉丁裔FQHC年度邮寄FIT外展计划的一部分。作为美国国立卫生研究院资助的PROMPT研究的一部分，我们确定了FIT结果异常的患者，并使用逻辑回归来评估患者人口统计学与接受随访结肠镜检查之间的关系，控制了患者的首选语言。我们报告转诊时间（天）和结肠镜检查时间。对于FIT结果异常但没有结肠镜检查证据的图表，我们进行了人工抽象化，并获得了没有结肠镜检查的原因。当患者的电子健康记录（EHR）中没有结肠镜检查的证据时，我们对行政索赔数据库进行自动查询，以确定结肠镜检查结果。我们从2018年7月至10月确定了324例FIT结果异常的患者。这些患者大多是公共保险（医疗补助53.1%，医疗保险14.5%），81.8%年龄在50至64岁之间，55.3%为女性，80.3%为西班牙裔/拉丁裔，67.3%倾向于说西班牙语。我们发现324例患者中有108例（33.3%）在12个月内完成结肠镜检查，中位结肠镜检查时间为94天（IQR: 68-176）。从图表提取的数据中得出，结肠镜检查完成的常见障碍是：转介给胃肠道（GI）专家或GI咨询后没有记录（41.6%），异常粪便检查后没有转介给胃肠道专家（34.2%），缺乏有效的保险授权（6.5%）。需要多层次的策略来为FQHC患者提供跨癌症连续体的最佳护理。为了降低结直肠癌的风险，实现粪便检测投资的回报，迫切需要系统层面的协调努力，以提高FQHC患者的结肠镜随访率，纠正结直肠癌筛查结果的种族和民族差异。
Individuals with an abnormal fecal immunochemical test (FIT) result have an elevated risk of colorectal cancer, and the risk increases if the follow-up colonoscopy is delayed. Of note, rates of follow-up colonoscopy are alarmingly low in federally qualified health centers (FQHCs), US health care settings that serve a majority racial and ethnic minority patient population. We assessed factors associated with colonoscopy after an abnormal FIT result and used chart-abstracted data to assess reasons (including process measures) for lack of follow-up as part of an annual, mailed-FIT outreach program within a large, Latino-serving FQHC. As part of the National Institutes of Health-funded PROMPT study, we identified patients with an abnormal FIT result and used logistic regression to assess associations between patient demographics and receipt of follow-up colonoscopy, controlling for patients’ preferred language. We report on time (days) to referral and time to colonoscopy. For charts with an abnormal FIT result but no evidence of colonoscopy, we performed a manual abstraction and obtained the reason for the absence of colonoscopy. When there was no evidence of colonoscopy in a patient’s electronic health record (EHR), we performed an automated query of the administrative claims database to identify colonoscopy outcomes. We identified 324 patients with abnormal FIT results from July to October 2018. These patients were mostly publicly insured (Medicaid 53.1%, Medicare 14.5%), 81.8% were aged 50 to 64 years, 55.3% were female, 80.3% were Hispanic/Latino, and 67.3% preferred to speak Spanish. We found that 108/324 (33.3%) patients completed colonoscopy within 12 months, and the median time to colonoscopy was 94 days (IQR: 68-176). Common barriers to colonoscopy completion, obtained from chart-abstracted data, were: no documentation following referral to gastrointestinal (GI) specialist or GI consultation (41.6%), no referral to GI specialist following abnormal fecal test (34.2%), and absence of a valid insurance authorization (6.5%). Multi-level strategies are needed to provide optimal care across the cancer continuum for FQHC patients. In order to reduce the risk of CRC and realize the return on fecal testing investment, concerted system-level efforts are urgently needed to improve rates of follow-up colonoscopy among FQHC patients and redress racial and ethnic disparities in CRC screening outcomes.
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影响因子：
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作者：
Coury J;Miech EJ;Styer P;Petrik AF;Coates KE;Green BB;Baldwin LM;Shapiro JA;Coronado GD
通讯作者：
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DOI：
10.1158/1055-9965.epi-15-0470
发表时间：
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期刊：
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DOI：
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发表时间：
2022-01-29
期刊：
Healthcare (Basel, Switzerland)
影响因子：
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通讯作者：
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DOI：
10.3322/caac.21452
发表时间：
2018-05
期刊：
CA: a cancer journal for clinicians
影响因子：
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影响因子：
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