title: Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems.
abstract: BACKGROUND
  To reduce colorectal cancer mortality, positive fecal blood tests must be followed by colonoscopy.
  
  
  METHODS
  We identified 62,384 individuals ages 50 to 89 years with a positive fecal blood test between January 1, 2011 and December 31, 2012 in four health care systems within the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We estimated the probability of follow-up colonoscopy and 95% confidence intervals (CI) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. HRs and 95% CIs were estimated from multivariate Cox proportional hazards models.
  
  
  RESULTS
  Most patients who received a colonoscopy did so within 6 months of their positive fecal blood test, although follow-up rates varied across health care systems (P <0.001). Median days to colonoscopy ranged from 41 (95% CI, 40-41) to 174 (95% CI, 123-343); percent followed-up by 12 months ranged from 58.1% (95% CI, 51.6%-63.7%) to 83.8% (95% CI, 83.4%-84.3%) and differences across health care systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower follow-up rates.
  
  
  CONCLUSIONS
  Individual characteristics and health care system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across health care systems, but proportions of patients receiving follow-up varied. These findings suggest that there is room to improve follow-up of positive colorectal cancer screening tests.
  
  
  CONCLUSIONS
  Understanding the timing of colonoscopy after positive fecal blood tests and characteristics associated with lack of follow-up may inform future efforts to improve follow-up.
authors: Group Health Research Institute, Seattle, Washington. chubak.j@ghc.org.
authors: Jessica
authors: J
authors: Chubak
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Michael P
authors: MP
authors: Garcia
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington. Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors: Andrea N
authors: AN
authors: Burnett-Hartman
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Yingye
authors: Y
authors: Zheng
authors: Kaiser Permanente Northern California, Oakland, California.
authors: Douglas A
authors: DA
authors: Corley
authors: Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Ethan A
authors: EA
authors: Halm
authors: Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Amit G
authors: AG
authors: Singal
authors: Office of the Director, NIH, Rockville, Maryland.
authors: Carrie N
authors: CN
authors: Klabunde
authors: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Chyke A
authors: CA
authors: Doubeni
authors: Group Health Research Institute, Seattle, Washington.
authors: Aruna
authors: A
authors: Kamineni
authors: Kaiser Permanente Medical Center, Walnut Creek, California.
authors: Theodore R
authors: TR
authors: Levin
authors: Kaiser Permanente Southern California, Pasadena, California.
authors: Joanne E
authors: JE
authors: Schottinger
authors: Group Health Research Institute, Seattle, Washington.
authors: Beverly B
authors: BB
authors: Green
authors: Kaiser Permanente Southern California, Pasadena, California.
authors: Virginia P
authors: VP
authors: Quinn
authors: RAND Corporation, Santa Monica, California.
authors: Carolyn M
authors: CM
authors: Rutter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D012307:Risk Factors; D013997:Time Factors; D014481:United States