title: Disparities in evaluation of patients with rectal bleeding 40 years and older.
abstract: OBJECTIVE
  Rectal bleeding is associated with colorectal cancer. We characterized the evaluation of patients aged 40 years and older with rectal bleeding and identified characteristics associated with inadequate evaluation.
  
  
  METHODS
  We conducted a retrospective review of records of outpatient visits that contained reports of rectal bleeding for patients aged 40 years and older (N = 480). We studied whether patient characteristics affected whether or not they received a colonoscopy examination within 90 days of presentation with rectal bleeding. Patient characteristics included demographics; family history of colon cancer and polyps; and histories of screening colonoscopies, physical examinations, referrals to specialists at the index visit, and communication of laboratory results. Data were collected from medical records, and patient income levels were estimated based on Zip codes.
  
  
  RESULTS
  Nearly half of the patients presenting with rectal bleeding received colonoscopies (48.1%); 81.7% received the procedure within 90 days. A history of a colonoscopy examination was more likely to be reported in white patients compared with Hispanic or Asian patients (P = .012 and P = .006, respectively), and in high-income compared with low-income patients (P = .022). A family history was more likely to be documented among patients with private insurance than those with Medicaid or Medicare (P = .004). A rectal examination was performed more often for patients who were white or Asian, male, and with high or middle incomes, compared with those who were black, Hispanic, female, or with low incomes (P = .027). White patients were more likely to have their laboratory results communicated to them than black patients (P = .001).
  
  
  CONCLUSIONS
  Sex, race, ethnicity, patient income, and insurance status were associated with disparities in evaluation of rectal bleeding. There is a need to standardize the evaluation of patients with rectal bleeding.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. Electronic address: hmshields@partners.org.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Shields
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Stoffel
authors.affiliation: Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Chung
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Health Care Policy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Harvard Vanguard Medical Associates, Harvard Medical School, Boston, Massachusetts.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
authors.affiliation: Center for Patient Safety, Harvard Medical School, Boston, Massachusetts.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Li
authors.affiliation: Center for Evaluation, Harvard Medical School, Boston, Massachusetts.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pelletier
authors.affiliation: Center for Patient Safety, Harvard Medical School, Boston, Massachusetts.
authors.forename: Justin
authors.initials: J
authors.lastname: Spencer
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Silk
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Bonita L
authors.initials: BL
authors.lastname: Austin
authors.affiliation: Harvard Vanguard Medical Associates, Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Diguette
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Furbish
authors.affiliation: Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lederman
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Center for Patient Safety, Harvard Medical School, Boston, Massachusetts.
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors
keywords: Age; Colorectal Cancer; Early Detection; Patient Management
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