title: Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients.
abstract: Fecal occult blood testing (FOBT) is a pragmatic screening option for many community health centers (CHCs), but FOBT screening programs will not reduce mortality if patients with positive results do not undergo diagnostic colonoscopy (DC). This study was conducted to investigate DC completion among CHC patients.
  
  
  
  This retrospective cohort study used data from three CHCs in the Midwest and Southwest. The primary study outcome was DC completion within 6 months of positive FOBT among adults age 50-75. Patient data was collected using automated electronic queries. Manual chart reviews were conducted if queries produced no evidence of DC. Poisson regression models described adjusted relative risks (RRs) of DC completion.
  
  
  
  The study included 308 patients; 63.3 % were female, 48.7 % were Spanish speakers and 35.7 % were uninsured. Based on combined query and chart review findings, 51.5 % completed DC. Spanish speakers were more likely than English speakers to complete DC [RR 1.19; 95 % confidence interval (CI) 1.04-1.36; P = 0.009], and DC completion was lower among patients with 0 visits than those with 1-2 visits (RR 2.81; 95% CI 1.83-4.33; P < 0.001) or ≥3 visits (RR 3.06; 95% CI 1.57-5.95; P = 0.001).
  
  
  
  DC completion was low overall, which raises concerns about whether FOBT can reduce CRC mortality in practice. Further research is needed to understand whether CHC navigator programs can achieve very high DC rates. If organizations use FOBT as their primary CRC screening approach and a substantial number of patients receive positive results, both screening rates and DC rates should be measured.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th floor, Chicago, IL, 60611, USA. david.liss@northwestern.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Liss
authors.affiliation: Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th floor, Chicago, IL, 60611, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Brown
authors.affiliation: Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th floor, Chicago, IL, 60611, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: PCC Community Wellness Center, Oak Park, IL, USA.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Altergott
authors.affiliation: Erie Family Health Center, Chicago, IL, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Buchanan
authors.affiliation: North Country HealthCare, Flagstaff, AZ, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Newland
authors.affiliation: Alliance of Chicago Community Health Services, Chicago, IL, USA.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Park
authors.affiliation: Alliance of Chicago Community Health Services, Chicago, IL, USA.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Rittner
authors.affiliation: Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th floor, Chicago, IL, 60611, USA.|The Joint Commission, Oakbrook Terrace, IL, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D017057:Medically Uninsured; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Cancer screening; Colorectal cancer; Diagnosis; Disparities; Preventive care