title: A centrally generated primary care physician audit report does not improve colonoscopy uptake after a positive result on a fecal occult blood test in Ontario's ColonCancerCheck program.
abstract: BACKGROUND
  Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (fobt) result within Ontario's population-wide ColonCancerCheck Program.
  
  
  METHODS
  This prospective cohort study used data sets from Ontario's ColonCancerCheck Program (2008-2011) that were linked to provincial administrative health databases. Cox proportional hazards regression was used to estimate the effect of centralized, physician-targeted audit and feedback on colonoscopy uptake in an Ontario-wide fobt-positive cohort.
  
  
  RESULTS
  A mailed physician audit and feedback report identifying individuals outstanding for colonoscopy for 3 or more months after a positive fobt result did not increase the likelihood of colonoscopy uptake (hazard ratio: 0.95; 95% confidence interval: 0.79 to 1.13). Duration of positive fobt status was strongly inversely associated with the hazard of follow-up colonoscopy (pfor linear trend: <0.001).
  
  
  CONCLUSIONS
  In a large population-wide setting, centralized tracking in the form of physician-targeted mailed audit and feedback reports does not improve colonoscopy uptake for screening participants with a positive fobt result outstanding for 3 or more months. Mailed physician-targeted screening audit and feedback reports alone are unlikely to improve compliance with follow-up colonoscopy in Ontario. Other interventions such as physician audits or automatic referrals, demonstrated to be effective in other jurisdictions, might be warranted.
authors.affiliation: Sunnybrook Research Institute, Sunnybrook Health Sciences Centre.
authors.forename: D
authors.initials: D
authors.lastname: Stock
authors.affiliation: Department of Medicine, University of Toronto; Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health, University of Toronto; Institute of Health Policy Management and Evaluation, University of Toronto; Cancer Care Ontario.
authors.forename: L
authors.initials: L
authors.lastname: Rabeneck
authors.affiliation: Institute for Clinical Evaluative Sciences; Institute of Health Policy Management and Evaluation, University of Toronto; Department of General Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Medical Sciences, University of Toronto, and.
authors.forename: N N
authors.initials: NN
authors.lastname: Baxter
authors.affiliation: Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health, University of Toronto; Radiation Oncology, University of Toronto, Toronto, ON.
authors.forename: L F
authors.initials: LF
authors.lastname: Paszat
authors.affiliation: Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health, University of Toronto.
authors.forename: R
authors.initials: R
authors.lastname: Sutradhar
authors.affiliation: Institute for Clinical Evaluative Sciences.
authors.forename: L
authors.initials: L
authors.lastname: Yun
authors.affiliation: Department of Medicine, University of Toronto; Institute for Clinical Evaluative Sciences; Institute of Health Policy Management and Evaluation, University of Toronto; Cancer Care Ontario.
authors.forename: J
authors.initials: J
authors.lastname: Tinmouth
keywords: Fecal occult blood test; colonoscopy; colorectal cancer; program evaluation; screening