title: Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices.
abstract: BACKGROUND
  ColonCancerCheck (CCC), Ontario's organized colorectal cancer (CRC) screening program, uses guaiac fecal occult blood testing (gFOBT). To reduce CRC-related mortality, persons with a positive gFOBT must have colonoscopy. We identified factors associated with failure to have colonoscopy within 6months of a positive gFOBT.
  
  
  METHODS
  Population-based, retrospective cohort analysis of CCC participants with positive gFOBT (April 2008 to December 2009) using health administrative data. Patient, physician and health care utilization factors associated with a lack of follow-up colonoscopy were identified using descriptive and multivariate analyses.
  
  
  RESULTS
  There were 21,839 participants with a positive gFOBT; 14,091 (64%) had colonoscopy within 6months. The strongest factors associated with failure to follow-up were recent colonoscopy (in 2years prior vs. >10years or never, OR: 4.31, 95% C.I.: 3.82, 4.86), as well as repeat gFOBT (OR: 6.08, 95% C.I.: 5.46, 6.78) and hospital admission (OR: 4.35, 95% C.I.: 3.57, 5.26) in the follow-up period.
  
  
  CONCLUSIONS
  In the first 18months of the CCC Program, 1/3 of those with a positive gFOBT did not have colonoscopy within 6months. Identification of potentially modifiable factors associated with failure to follow up lay the groundwork for interventions to address this critical quality gap.
authors.affiliation: Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada. Electronic address: adriano.correia@trilliumhealthpartners.ca.
authors.forename: Adriano
authors.initials: A
authors.lastname: Correia
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Cancer Care Ontario, Toronto, Canada. Electronic address: Linda.Rabeneck@cancercare.on.ca.
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: BaxterN@smh.toronto.on.ca.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: lawrence.paszat@ices.on.ca.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Paszat
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: Rinku.Sutradhar@ices.on.ca.
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada. Electronic address: Lingsong.Yun@ices.on.ca.
authors.forename: Lingsong
authors.initials: L
authors.lastname: Yun
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Cancer Care Ontario, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: jill.tinmouth@sunnybrook.ca.
authors.forename: Jill
authors.initials: J
authors.lastname: Tinmouth
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006138:Guaiac; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D006138:Guaiac
keywords: Colonoscopy; Colorectal cancer; Fecal occult blood testing; Organized screening