Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review.
Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review.
复制标题
DOI：
10.1007/s11606-022-07657-4
复制
发表时间：
2023-01
影响因子：
5.7
通讯作者：
Sarkar, Urmimala
中科院分区：
文献类型：
--
作者：
Khoong, Elaine C.;Rivadeneira, Natalie A.;Pacca, Lucia;Schillinger, Dean;Lown, David;Babaria, Palav;Gupta, Neha;Pramanik, Rajiv;Tran, Helen;Whitezell, Tyler;Somsouk, Ma;Sarkar, Urmimala
对异常癌症筛查试验的不公平随访可能导致结肠癌和乳腺癌结局的种族/民族差异。然而，很少有多中心研究检查了异常癌症筛查试验的随访，并且不清楚是否存在种族/民族差异。本报告描述了结肠癌和乳腺癌筛查试验异常的后续表现模式，并探讨了公立医院系统中存在的种族/民族差异的程度。我们使用来自五个加州公立医院系统的数据进行了一项回顾性队列研究。我们使用多变量稳健泊松回归分析来检查患者水平因素或研究中心是否预测接受随访检查。我们使用2015年7月至2017年6月期间来自五家公立医院系统的数据，评估了两种筛查结果的随访：（1）粪便免疫化学试验（FIT）阳性后的结肠镜检查和（2）BIRADS 4/5乳房X线检查后21天内的组织活检。在4132例异常FIT中，1736例（42%）接受了随访结肠镜检查。年龄较大、医疗保险、缺乏保险、英语和地点与随访结肠镜检查呈负相关，而西班牙裔和亚裔与随访结肠镜检查呈正相关。在1702例BIRADS 4/5乳腺X线摄影中，1082例（64%）接受了及时活检;只有研究中心与及时随访活检相关。尽管公立医院系统的患者的脆弱性，异常癌症筛查测试的后续发生率与其他医疗机构的患者相似，结肠癌筛查测试的后续发生率低于乳腺癌筛查测试的后续。与患者的社会人口特征相比，研究中心水平的因素对随访率的影响更大，更一致。需要资源来确定卫生系统一级的因素，如检测后续程序或数据基础设施，以改善异常癌症筛查检测后续工作，从而能够评价和传播有效的卫生系统一级干预措施。在线版本包含补充材料，可通过10.1007/s11606-022-07657-4获得。
Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist. This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test. Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram. Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy. Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system–level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system–level interventions can be evaluated and disseminated. The online version contains supplementary material available at 10.1007/s11606-022-07657-4.
登录
查看更多内容
影响因子：
3.3
作者：
Chen, Eric T.;Eder, Mickey;Hickner, John
通讯作者：
Hickner, John
影响因子：
29.4
作者：
Lai Y;Wang C;Civan JM;Palazzo JP;Ye Z;Hyslop T;Lin J;Myers RE;Li B;Jiang B;Sama A;Xing J;Yang H
通讯作者：
Yang H
影响因子：
120.7
作者：
Corley, Douglas A.;Jensen, Christopher D.;Levin, Theodore R.
通讯作者：
Levin, Theodore R.
影响因子：
2.7
作者：
Khoong, Elaine C.;Cherian, Roy;Sarkar, Urmimala
通讯作者：
Sarkar, Urmimala
DOI：
10.1093/jamia/ocx080
发表时间：
2017-11-01
影响因子：
6.4
作者：
Adler-Milstein, Julia;Holmgren, A. Jay;Patel, Vaishali
通讯作者：
Patel, Vaishali