Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems.
Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems.
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DOI：
10.1158/1055-9965.epi-15-0470
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
PROSPR consortium
中科院分区：
文献类型：
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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
为了降低结直肠癌（CRC）的死亡率，粪便血检阳性后必须进行结肠镜检查。我们确定了62，384名年龄在50-89岁之间的个体，他们在2011年1月1日至2012年12月31日期间在基于人群的研究通过个性化方案优化筛选（PROSPR）联盟的四个医疗保健系统中进行了阳性粪便血液检测。我们使用Kaplan-Meier方法估计随访结肠镜检查的概率和95%置信区间（CI）。采用对数秩检验评估了不同医疗保健系统随访累积发生率的总体差异。根据多变量考克斯比例风险模型估计风险比和95% CI。大多数接受结肠镜检查的患者在粪便血检阳性的6个月内进行了结肠镜检查，尽管不同医疗系统的随访率不同（p <0.001）。结肠镜检查的中位天数为41（95% CI，40-41）至174（95% CI，123-343）; 12个月随访百分比范围为58.1%（95% CI，51.6%-63.7%）至83.8%（95% CI，83.4%-84.3%），并且在1、2、3和6个月时也观察到医疗保健系统之间的差异。年龄和合并症评分的增加与随访率降低相关。个体特征和医疗保健系统与粪便血试验阳性后的结肠镜检查相关。模式在医疗保健系统中是一致的，但接受随访的患者比例各不相同。这些发现表明，有空间改善积极的CRC筛查试验的后续工作。了解粪便血检阳性后结肠镜检查的时间以及与缺乏随访相关的特征可能会为未来改善随访提供信息。
To reduce colorectal cancer (CRC) mortality, positive fecal blood tests must be followed by colonoscopy. We identified 62,384 individuals aged 50–89 years with a positive fecal blood test between 1/1/2011 and 12/31/2012 in four healthcare systems within the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We estimated the probability of follow-up colonoscopy and 95% confidence intervals (CIs) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. Hazard ratios and 95% CIs were estimated from multivariate Cox proportional hazards models. Most patients who received a colonoscopy did so within six months of their positive fecal blood test, although follow-up rates varied across healthcare systems (p <0.001). Median days to colonoscopy ranged from 41 (95% CI, 40–41) to 174 (95% CI, 123–343); percent followed-up by 12-months ranged from 58.1% (95% CI, 51.6%–63.7%) to 83.8% (95% CI, 83.4%–84.3%) and differences across healthcare systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower follow-up rates. Individual characteristics and healthcare system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across healthcare systems, but proportions of patients receiving follow-up varied. These findings suggest there is room to improve follow-up of positive CRC screening tests. Understanding the timing of colonoscopy after positive fecal blood tests and characteristics associated with lack of follow-up may inform future efforts to improve follow-up.