Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization.
BACKGROUND
Screening for fecal occult blood can be effective in reducing colorectal cancer mortality only if positive tests are appropriately followed up with complete diagnostic evaluation (ie, colonoscopy or flexible sigmoidoscopy with double contrast barium enema) and treatment.


OBJECTIVE
To examine whether rates of complete diagnostic evaluation after a positive fecal occult blood test (FOBT) have improved over time after the implementation of tracking systems and physician guidelines within a large integrated health care organization.


METHODS
From 1993 to 2005, 8513 positive FOBTs were identified on 8291 enrollees aged 50-79 of a large health care system. Automated records were used to identify repeat FOBTs, colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema within 1 year after the positive FOBT. National rates of complete diagnostic evaluation were estimated from the 2005 National Health Interview Survey.


RESULTS
In this integrated health care organization, the percentage of positive FOBTs followed by complete diagnostic evaluation within 1 year increased from 57-64% in 1993-1996 to 82-86% from 2000-2005. Use of repeat FOBT after a positive FOBT decreased from 28-31% in 1993-1996 to 6-11% in 2000-2005. Based on the National Health Interview Survey, only 52% of positive FOBTs in 2000-2005 were followed by complete diagnostic evaluation nationally.


CONCLUSIONS
Adherence to recommendations for complete diagnostic evaluation after a positive FOBT has greatly improved over time in an integrated group medical practice. Through the use of tracking systems and screening guidelines, it may be possible to reach levels of follow-up that are comparable to those observed in randomized trials.
Miglioretti
Diana L
DL
Group Health Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA. miglioretti.d@ghc.org
Rutter
Carolyn M
CM
Bradford
Susan Carol
SC
Zauber
Ann G
AG
Kessler
Larry G
LG
Feuer
Eric J
EJ
Grossman
David C
DC
D000368:Aged; D001466:Barium Sulfate; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005243:Feces / Q000737:chemistry; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D001466:Barium Sulfate