title: Reasons for Lack of Diagnostic Colonoscopy After Positive Result on Fecal Immunochemical Test in a Safety-Net Health System.
abstract: BACKGROUND
  Effective colorectal cancer screening depends on timely diagnostic evaluation in patients with abnormal results on fecal immunochemical tests (FITs). Although prior studies suggest low rates of follow-up colonoscopy, there is little information among patients in safety-net health systems and few data characterizing reasons for low follow-up rates. This study aimed to characterize factors contributing to lack of follow-up colonoscopy in a racially diverse and socioeconomically disadvantaged cohort of patients with abnormal results on FIT ("abnormal FIT" for brevity) receiving care in an integrated safety-net health system.
  
  
  METHODS
  We performed a retrospective electronic medical record review of patients aged 50-64 years with abnormal FIT at a population-based safety-net health system between January 2010 and July 2013. Review of electronic medical records focused on patients without follow-up colonoscopy to characterize patient-, provider-, and system-level reasons for lack of diagnostic evaluation. We used logistic regression analysis to identify predictors of follow-up colonoscopy within 12 months of abnormal FIT.
  
  
  RESULTS
  Of 1267 patients with abnormal FIT, 536 (42.3%) failed to undergo follow-up colonoscopy within 1 year. Failure was attributable to patient-level factors in 307 (57%) cases, provider factors in 97 (18%) cases, and system factors in 118 (22%) cases. In multivariate analysis, follow-up colonoscopy was less likely among those aged 61-64 years (odds ratio 0.63, 95% confidence interval 0.46-0.87) compared with 50-55 year olds.
  
  
  CONCLUSIONS
  Nearly half (42%) of patients with abnormal FIT failed to undergo follow-up colonoscopy within 1 year. Lack of diagnostic evaluation is related to a combination of patient-, provider-, and system-level factors, highlighting the need for multilevel interventions to improve follow-up colonoscopy completion rates.
authors: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Tex; Parkland Health & Hospital System, Dallas, Tex.
authors: Jason
authors: J
authors: Martin
authors: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Tex; Parkland Health & Hospital System, Dallas, Tex; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex.
authors: Ethan A
authors: EA
authors: Halm
authors: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex.
authors: Jasmin A
authors: JA
authors: Tiro
authors: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Tex.
authors: Zahra
authors: Z
authors: Merchant
authors: Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex; Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health - Dallas Campus, Dallas, Tex.
authors: Bijal A
authors: BA
authors: Balasubramanian
authors: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex.
authors: Katharine
authors: K
authors: McCallister
authors: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex.
authors: Joanne M
authors: JM
authors: Sanders
authors: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex.
authors: Chul
authors: C
authors: Ahn
authors: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex.
authors: Wendy Pechero
authors: WP
authors: Bishop
authors: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Tex; Parkland Health & Hospital System, Dallas, Tex; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex. Electronic address: amit.singal@utsouthwestern.edu.
authors: Amit G
authors: AG
authors: Singal
mesh_terms: D000367:Age Factors; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D013781:Texas
keywords: Colonoscopy; Colorectal cancer screening; Fecal immunochemical test; Randomized controlled trial; Safety-net health system