title: Timely follow-up of positive fecal occult blood tests strategies associated with improvement.
abstract: BACKGROUND
  In light of previous research indicating that many patients fail to receive timely diagnostic follow-up of positive colorectal cancer (CRC) screening tests, the Veterans Health Administration (VA) initiated a national CRC diagnosis quality-improvement (QI) effort.
  
  
  OBJECTIVE
  This article documents the percent of patients receiving follow-up within 60 days of a positive CRC screening fecal occult blood test (FOBT) and identifies improvement strategies that predict timely follow-up.
  
  
  METHODS
  In 2007, VA facilities completed a survey in which they indicated the degree to which they had implemented a series of improvement strategies and described barriers to improvement. Three types of strategies were assessed: developing QI infrastructure, improving care delivery processes, and building gastroenterology capacity. Survey data were merged with a measure of 60-day positive-FOBT follow-up. Facility-level predictors of timely follow-up were identified and relationships among categories of improvement strategies were assessed. Data were analyzed in 2008.
  
  
  RESULTS
  The median facility-reported 60-day follow-up rate for positive screening FOBTs was 24.5%. Several strategies were associated with timeliness of follow-up. The relationship between the implementation of QI infrastructure strategies and timely follow-up was mediated by the implementation of process-change strategies. Although constraints on gastroenterology capacity were often sited as a key barrier, implementation of strategies to address this issue was unassociated with timely follow-up.
  
  
  CONCLUSIONS
  Developing QI infrastructure appears to be an effective strategy for improving FOBT follow-up when this work is followed by process improvements. Increasing gastroenterology capacity may be more difficult than improving processes of care.
authors.affiliation: Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA. adam.powell@va.gov
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gravely
authors.forename: Diana L
authors.initials: DL
authors.lastname: Ordin
authors.forename: James E
authors.initials: JE
authors.lastname: Schlosser
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards; D005500:Follow-Up Studies; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009780:Occult Blood; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs