title: Improving the follow-up of positive hemoccult screening tests: an electronic intervention.
abstract: BACKGROUND
  Four population-based studies of screening for CRC with fecal occult blood testing (FOBT) have shown that mortality can be significantly reduced. However, nearly half of all positive screening tests are not appropriately evaluated.
  
  
  OBJECTIVE
  We evaluated whether an electronic record intervention improved the follow-up of patients with a positive FOBT (FOBT+) result.
  
  
  METHODS
  We conducted a cluster randomized trial involving four Veteran's Affairs (VA) medical centers pair-matched by colonoscopy volume and randomized within the pair to receive the electronic intervention or usual care.
  
  
  METHODS
  All patients with FOBT+ results at participating facilities during a matched pre- and post-intervention time period.
  
  
  METHODS
  In the two intervention sites, an electronic consult that imported relevant clinical information was automatically submitted to the gastroenterology (GI) clinic for all FOBT+ patients at the time the result was recorded in the laboratory. In both intervention and control sites (usual care), PCPs continued to be notified of FOBT+ results in the usual manner
  
  
  METHODS
  Pre- and post-intervention changes in the proportion of FOBT+ patients having: (1) a GI consult or (2) a GI consult plus complete diagnostic evaluation (CDE) of the colon within 30, 90 and 180 days were compared across intervention and control sites. Log rank tests were used to determine statistical significance.
  
  
  RESULTS
  The 30-, 90- and 180-day GI consult rates improved 21-33 % (p < 0.001) among intervention sites, but did not change in the usual care sites. Thirty-, 90- and 180-day CDE rates improved 9-31% (p < 0.03) in intervention sites, but did not significantly change in the usual care sites. Time to GI consult and CDE decreased significantly over time in the intervention sites (p < 0.001), but remained unchanged in the usual care sites.
  
  
  CONCLUSIONS
  The relatively simple electronic intervention evaluated can significantly improve the follow-up of FOBT+ results. Interventions such as this could improve patient care and may be applicable to other practice settings, as well as other types of tests.
authors.affiliation: The Portland Veterans Affairs Medical Center, Portland, OR 97239, USA. Linda.Humphrey@va.gov
authors.forename: Linda L
authors.initials: LL
authors.lastname: Humphrey
authors.forename: Jackilen
authors.initials: J
authors.lastname: Shannon
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
authors.forename: Jean
authors.initials: J
authors.lastname: O'Malley
authors.forename: Zunqiu
authors.initials: Z
authors.lastname: Chen
authors.forename: Mark
authors.initials: M
authors.lastname: Helfand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs