title: Evaluation of a VHA collaborative to improve follow-up after a positive colorectal cancer screening test.
abstract: BACKGROUND
  In 2005, the Veterans Health Administration initiated a yearlong Colorectal Cancer Care Collaborative (C4) to improve timely follow-up after positive fecal occult blood tests.
  
  
  METHODS
  Twenty-one facilities formed local quality improvement (QI) teams. Teams received QI training, created process flow maps, implemented process changes, and shared learning through 2 face-to-face meetings, conference calls, and a discussion board. We evaluated pre-post change in the timeliness of follow-up among C4 facilities and 3 control facilities. Outcome measures included the proportion of patients receiving a follow-up colonoscopy within 1 year, the proportion receiving 60-day follow-up (the focus of C4 teams), and average days to colonoscopy. Survey data from C4 team members was analyzed to identify predictors of facility-level improvement.
  
  
  RESULTS
  Both C4 and control facilities improved on 1-year follow-up (10% and 9% increases, respectively, both P's<0.001). There was a statistically significant increase in the proportion receiving 60-day follow-up among C4 facilities (27% pre-C4 vs. 39% post-C4, P=0.008) but a nonsignificant decrease among control facilities (45% pre-C4 vs. 29% post-C4, P=0.14). Average days to colonoscopy decreased significantly among C4 facilities (129 pre-C4 vs. 103 post-C4, P=0.004) but increased significantly among control facilities (81 pre-C4 vs. 103 post-C4, P=0.04). Teams with the most improvement established clear roles/goals, had previous QI training, made more use of QI tools, and incorporated primary care education into their improvement work.
  
  
  CONCLUSIONS
  A Veterans Health Administration improvement collaborative modestly decreased time to colonoscopy after a positive colorectal cancer screening test but significant room for improvement remains and benefits of participation were not realized by all facilities.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, USA. Adam.Powell@va.gov
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Sean
authors.initials: S
authors.lastname: Nugent
authors.forename: Diana L
authors.initials: DL
authors.lastname: Ordin
authors.forename: Siamak
authors.initials: S
authors.lastname: Noorbaloochi
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003266:Continuity of Patient Care / Q000592:standards*; D003299:Cooperative Behavior; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D011785:Quality Assurance, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs