title: Analysis of colorectal cancer stage among HMO members targeted for screening.
abstract: BACKGROUND
  This study is a retrospective analysis of data collected from patient medical records, a fecal occult blood test (FOBT) screening program, and computerized health maintenance organization (HMO) claims and encounters records.
  
  
  OBJECTIVE
  To identify factors associated with a diagnosis of early (Dukes A and B) colorectal cancer among older adults targeted for annual FOBT screening.
  
  
  METHODS
  Study subjects were insured by the former US Healthcare Inc (Blue Bell, Pa), an independent practice association-type HMO. The HMO was recently integrated into Aetna-US Healthcare. Before diagnosis, subjects were eligible for free annual FOBT screening through the HMO's colorectal cancer screening program. The study subjects included men and women (N = 222) who were aged 50 years or older and had a diagnosis of colorectal cancer between 1987 and 1990. Variables considered were patient age, gender, socioeconomic status, medical history, screening history, length of enrollment in the HMO, and stage of disease at diagnosis.
  
  
  RESULTS
  Univariate analyses indicate that colorectal cancer diagnosis due to FOBT screening (P = .03), frequency of FOBT screening (P = .09), and length of HMO membership (P = .10) were positively related to being diagnosed as having early stage colorectal cancer. Multivariable analysis shows that having a screen-detected colorectal cancer was significantly and positively related (P = .03) to being diagnosed as having early stage disease.
  
  
  CONCLUSIONS
  Findings support annual FOBT screening among older adults. Results illustrate the value of applying standard methods to the collection and analysis of patient data in a managed care context. The study also highlights a need for research on patient adherence to screening and physician follow-up of abnormal screening test results.
authors.affiliation: Behavioral Epidemiology Section, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Myers
authors.forename: J
authors.initials: J
authors.lastname: Murray
authors.forename: D
authors.initials: D
authors.lastname: Weinberg
authors.forename: G
authors.initials: G
authors.lastname: McGrory
authors.forename: T
authors.initials: T
authors.lastname: Wolf
authors.forename: J
authors.initials: J
authors.lastname: Caveny
authors.forename: N
authors.initials: N
authors.lastname: Hanchak
authors.forename: N
authors.initials: N
authors.lastname: Schlackman
authors.forename: R
authors.initials: R
authors.lastname: Comis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000517:prevention & control; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009515:New Jersey; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010414:Pennsylvania; D012189:Retrospective Studies; D012959:Socioeconomic Factors