Colorectal Cancer Testing in the National Veterans Health Administration
Colorectal Cancer Testing in the National Veterans Health Administration
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DOI：
10.1007/s10620-011-1895-4
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发表时间：
2012-02-01
影响因子：
3.1
通讯作者：
Fisher, Deborah A.
中科院分区：
文献类型：
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作者：
Long, Millie D.;Lance, Trang;Fisher, Deborah A.
结直肠癌（CRC）筛查是退伍军人健康管理局（VHA）的优先事项。优化粪便潜血试验（FOBT）是卫生保健系统中CRC筛查不可或缺的一部分。本研究的目的是描述大型综合卫生保健系统（VHA）中CRC试验的利用率，通过FOBT确定CRC检测的当前比率，并检查与缺乏FOBT卡返回相关的因素。VHA质量和性能办公室（OQP）从2008年10月至2009年9月的全国退伍军人样本中收集数据。计算符合条件的退伍军人的CRC检测率和方式。在那些提供FOBT，双变量分析进行描述的FOBT回报的人口特征。使用逻辑回归来确定与缺乏FOBT回报相关的独立因素。总共纳入了36，336名退伍军人。在加权分析中，80.4%的退伍军人接受了某种形式的CRC筛查。大多数患者在前10年接受了结肠镜检查（71.6%），其次是前一年接受了FOBT（24.0%）。共有31.0%的人没有归还所提供的FOBT卡。与缺乏FOBT返回相关的因素包括：年轻，女性，非高加索种族，居住在东北部，目前吸烟和缺乏流感疫苗接种。VHA内基于系统的实践可能在成功的CRC筛查中发挥作用。CRC筛查最常通过结肠镜检查，其次是FOBT。与不遵守FOBT相关的特征可能会为医疗保健系统未来的质量改进计划提供信息。
Colorectal cancer (CRC) screening is a priority for the Veteran's Health Administration (VHA). Optimizing fecal occult blood testing (FOBT) is integral to CRC screening in health care systems.The purpose of this study was to characterize the utilization of CRC testing in a large integrated health care system (VHA), determine current rates of CRC testing by FOBT and examine factors associated with lack of FOBT card return.The VHA Office of Quality and Performance (OQP) collected data from a national sample of Veterans from October 2008 to September 2009. Rates and modality of CRC testing for eligible Veterans were calculated. Among those offered FOBT, bivariate analyses were performed to describe population characteristics by FOBT return. Logistic regression was used to determine factors independently associated with lack of FOBT return.A total of 36,336 Veterans were included. On weighted analysis, 80.4% of Veterans received a form of CRC screening. The majority underwent colonoscopy in the prior 10 years (71.6%), followed by FOBT in the prior year (24.0%). A total of 31.0% did not return FOBT cards that were provided. Factors associated with a lack of FOBT return included: younger age, female gender, non-Caucasian race, living in the Northeast, current smoking and lack of influenza vaccination.Overall rates of CRC screening in VHA are high. Systems-based practices within VHA likely play a role in successful CRC screening. CRC screening is most often via colonoscopy, followed by FOBT. Characteristics associated with non-adherence with FOBT may inform future quality improvement initiatives in health care systems.