title: Impact of a physician-oriented intervention on follow-up in colorectal cancer screening.
abstract: BACKGROUND
  Complete diagnostic evaluation or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray) is often not performed for persons with an abnormal screening fecal occult blood test (FOBT+) result.
  
  
  METHODS
  This study evaluated the impact of a reminder-feedback and educational outreach intervention on primary care practice CDE recommendation and performance rates. Four hundred seventy primary care physicians (PCPs) in 318 practices participated in the study. Patients were mailed an FOBT kit annually as part of a screening program. Practices were randomly assigned to a Control Group (N = 198) or an Intervention Group (N = 120). During an 18-month pre-randomization period and a 9-month post-randomization period, 2992 screening FOBT+ patients were identified. Intervention practices received the screening program and the intervention. Control practices received only the screening program. Study outcomes were baseline-adjusted CDE recommendation and performance rates.
  
  
  RESULTS
  At baseline, about two-thirds of FOBT+ patients received a CDE recommendation, and about half had a CDE performed. At endpoint, CDE recommendation and performance rates were both significantly higher for the Intervention as compared to the Control practices (OR = 2.28; 95% CI: 1.37, 3.78, and OR = 1.63; 95% CI: 1.06, 2.50, respectively).
  
  
  CONCLUSIONS
  The reminder-feedback plus educational outreach intervention significantly increased CDE recommendation and performance.
authors.affiliation: Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA. ron.myers@mail.tju.edu
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Myers
authors.forename: Barbara
authors.initials: B
authors.lastname: Turner
authors.forename: David
authors.initials: D
authors.lastname: Weinberg
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
authors.forename: Timothy
authors.initials: T
authors.lastname: Brigham
authors.forename: Todd
authors.initials: T
authors.lastname: Rothermel
authors.forename: James
authors.initials: J
authors.lastname: Grana
authors.forename: Neil
authors.initials: N
authors.lastname: Schlackman
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D009780:Occult Blood; D010821:Physicians, Family / Q000193:education*; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine / Q000193:education*; D017010:Reminder Systems