Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes
Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes
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DOI：
10.1002/cncr.32440
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发表时间：
2019-09-03
期刊：
影响因子：
6.2
通讯作者：
Gupta, Samir
中科院分区：
文献类型：
--
作者：
Bharti, Balambal;May, Folasade (Fola) Popoola;Gupta, Samir
背景粪便免疫化学检测（FIT）筛查结直肠癌的有效性取决于对FIT异常的高结肠镜随访率和高质量检测的使用。这项研究的特点结肠镜转诊和完成异常的FIT患者和FIT的类型在南加州联邦合格的卫生中心（CIMHC）的样本中实施。方法圣地亚哥、帝国和洛杉矶县的CIMHC被邀请定义一个队列，该队列包括2015-2016年≥ 150例FIT异常的连续患者，并提供有关性别、保险状况、诊断性结肠镜检查转诊和异常FIT 6个月内完成情况以及实施的FIT类型（品牌）的数据。主要结局是每个CIMHC和总体上所有患者的结肠镜转诊比例和完成率。结果8家健康中心提供了1229例FIT异常患者的数据; 46%为男性，20%为未投保者。在FIT异常的患者中，89%（1229例中的1091例; 95%置信区间[CI]，0.87-0.91）接受了结肠镜检查转诊，44%（1229例中的539例; 95% CI，0.41-0.47）完成了结肠镜检查。在所有CIMCs中，结肠镜检查转诊的范围为73%至96%，完成范围为18%至57%。8个国家中有6个（75%）报告了FIT品牌，但支持其有效性的数据有限。结论：在南加州的一个样本中，异常FIT后的诊断性结肠镜检查完成率大大低于国家推荐的80%完成率的基准，并且使用有限数据支持其有效性的FIT品牌的比例很高。这些研究结果表明，需要政策和多层次的干预措施，以促进诊断性结肠镜检查异常的个体和使用更高质量的FIT。
Background The effectiveness of colorectal cancer screening with fecal immunochemical tests (FITs) of stool blood depends on high rates of colonoscopy follow-up for abnormal FITs and the use of high-quality tests. This study characterized colonoscopy referral and completion among patients with abnormal FITs and the types of FITs implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs). Methods FQHCs in San Diego, Imperial, and Los Angeles Counties were invited to define a cohort of >= 150 consecutive patients with abnormal FITs in 2015-2016 and to provide data on sex, insurance status, diagnostic colonoscopy referrals and completion within 6 months of abnormal FITs, and the types (brands) of FITs implemented. The primary outcomes were the proportions with colonoscopy referrals and completion for all patients at each FQHC and in aggregate. Results Eight FQHCs provided data for 1229 patients with abnormal FITs; 46% were male, and 20% were uninsured. Among patients with abnormal FITs, 89% (1091 of 1229; 95% confidence interval [CI], 0.87-0.91) had a colonoscopy referral, and 44% (539 of 1229; 95% CI, 0.41-0.47) had colonoscopy completion. Across FQHCs, the range for colonoscopy referral was 73% to 96%, and the range for completion was 18% to 57%. Six of the 8 FQHCs (75%) reported FIT brands with limited data to support their effectiveness. Conclusions In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FITs was substantially below the nationally recommended benchmark to achieve 80% completion, and the use of FIT brands with limited data to support their effectiveness was high. These findings suggest a need for policies and multilevel interventions to promote diagnostic colonoscopy among individuals with abnormal FITs and the use of higher quality FITs.