title: Variability in resource use: diagnosing colorectal cancer.
abstract: OBJECTIVE
  Efficient resource use is relevant in all healthcare systems. Although colorectal cancer is common, little has been published regarding the utilization of clinical resources in diagnosis.
  
  
  METHODS
  The primary aim was to evaluate the patterns and factors associated with clinical services used to diagnose colorectal cancer at 14 US Department of Veterans Affairs facilities. The secondary aim was to investigate whether using more clinical services was associated with time to diagnosis.
  
  
  METHODS
  We reviewed medical records for 449 patients with colorectal cancer in an observational study. Study end points were the use of clinical diagnostic services grouped as laboratory tests, imaging studies, and subspecialty consultations. Cumulative logistic regression models were used to explore factors associated with each outcome.
  
  
  RESULTS
  Facility variability contributed to the variability of resource use in all models. In adjusted analyses, older patients had higher use of laboratory tests (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.02-1.43) and incidentally discovered colorectal cancer was associated with increased use of consultations (OR, 1.97; 95% CI, 1.27-3.05), imaging studies (OR, 1.70; 95% CI, 1.12-2.58), and laboratory tests (OR, 3.14; 95% CI, 2.06-4.77) compared with screen-detected cancers. There was a strong direct correlation between thenumber of diagnostic services performed and the median time to diagnosis (Spearman correlation coefficient, 0.99; P < .001).
  
  
  CONCLUSIONS
  Variability in utilization of diagnostic clinical services was associated with patient age, patient presentation, and facility. Increased resource use was highly correlated with increased time to diagnosis.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Duke University Medical Center, DUMC Box 3913, Durham, NC 27710, USA. douglassrygley@gmail.com
authors.forename: F Douglas
authors.initials: FD
authors.lastname: Srygley
authors.forename: David H
authors.initials: DH
authors.lastname: Abbott
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fischer
mesh_terms: D000328:Adult; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D016001:Confidence Intervals; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D055815:Young Adult