title: Rates and correlates of potentially inappropriate colorectal cancer screening in the Veterans Health Administration.
abstract: BACKGROUND
  Inappropriate use of colorectal cancer (CRC) screening procedures can inflate healthcare costs and increase medical risk. Little is known about the prevalence or causes of inappropriate CRC screening.
  
  
  OBJECTIVE
  Our aim was to estimate the prevalence of potentially inappropriate CRC screening, and its association with patient and facility characteristics in the Veterans Health Administration (VHA) .
  
  
  METHODS
  We conducted a cross-sectional study of all VHA patients aged 50 years and older who completed a fecal occult blood test (FOBT) or a screening colonoscopy between 1 October 2009 and 31 December 2011 (n = 1,083,965).
  
  
  METHODS
  Measures included: proportion of patients whose test was classified as potentially inappropriate; associations between potentially inappropriate screening and patient demographic and health characteristics, facility complexity, CRC screening rates, dependence on FOBT, and CRC clinical reminder attributes.
  
  
  RESULTS
  Of 901,292 FOBT cases, 26.1 % were potentially inappropriate (13.9 % not due, 7.8 % limited life expectancy, 11.0 % receiving FOBT when colonoscopy was indicated). Of 134,335 screening colonoscopies, 14.2 % were potentially inappropriate (10.4 % not due, 4.4 % limited life expectancy). Each additional 10 years of patient age was associated with an increased likelihood of undergoing potentially inappropriate screening (ORs = 1.60 to 1.83 depending on screening mode). Compared to facilities scoring in the bottom third on a measure of reliance on FOBT (versus screening colonoscopy), facilities scoring in the top third were less likely to conduct potentially inappropriate FOBTs (OR = 0.,78) but more likely to conduct potentially inappropriate colonoscopies (OR = 2.20). Potentially inappropriate colonoscopies were less likely to be conducted at facilities where primary care providers were assigned partial responsibility (OR = 0.74) or full responsibility (OR = 0.73) for completing the CRC clinical reminder.
  
  
  CONCLUSIONS
  A substantial number of VHA CRC screening tests are potentially inappropriate. Establishing processes that enforce appropriate screening intervals, triage patients with limited life expectancies, and discourage the use of FOBTs when a colonoscopy is indicated may reduce inappropriate testing.
authors.affiliation: Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA, apowell913@gmail.com.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Sameer D
authors.initials: SD
authors.lastname: Saini
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Breitenstein
authors.forename: Siamak
authors.initials: S
authors.lastname: Noorbaloochi
authors.forename: Andrea
authors.initials: A
authors.lastname: Cutting
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Bloomfield
authors.forename: Krysten
authors.initials: K
authors.lastname: Halek
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health / Q000706:statistics & numerical data*