title: Colorectal cancer testing in the national Veterans Health Administration.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening is a priority for the Veteran's Health Administration (VHA). Optimizing fecal occult blood testing (FOBT) is integral to CRC screening in health care systems.
  
  
  OBJECTIVE
  The purpose of this study was to characterize the utilization of CRC testing in a large integrated health care system (VHA), determine current rates of CRC testing by FOBT and examine factors associated with lack of FOBT card return.
  
  
  METHODS
  The VHA Office of Quality and Performance (OQP) collected data from a national sample of Veterans from October 2008 to September 2009. Rates and modality of CRC testing for eligible Veterans were calculated. Among those offered FOBT, bivariate analyses were performed to describe population characteristics by FOBT return. Logistic regression was used to determine factors independently associated with lack of FOBT return.
  
  
  RESULTS
  A total of 36,336 Veterans were included. On weighted analysis, 80.4% of Veterans received a form of CRC screening. The majority underwent colonoscopy in the prior 10 years (71.6%), followed by FOBT in the prior year (24.0%). A total of 31.0% did not return FOBT cards that were provided. Factors associated with a lack of FOBT return included: younger age, female gender, non-Caucasian race, living in the Northeast, current smoking and lack of influenza vaccination.
  
  
  CONCLUSIONS
  Overall rates of CRC screening in VHA are high. Systems-based practices within VHA likely play a role in successful CRC screening. CRC screening is most often via colonoscopy, followed by FOBT. Characteristics associated with non-adherence with FOBT may inform future quality improvement initiatives in health care systems.
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Campus Box #7080, Chapel Hill, NC 27599-7080, USA. millie_long@med.unc.edu
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
authors.forename: Trang
authors.initials: T
authors.lastname: Lance
authors.forename: Douglas
authors.initials: D
authors.lastname: Robertson
authors.forename: Leila
authors.initials: L
authors.lastname: Kahwati
authors.forename: Linda
authors.initials: L
authors.lastname: Kinsinger
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs