BACKGROUND: Four population-based studies of screening for CRC with fecal occult blood testing (FOBT) have shown that mortality can be significantly reduced. However, nearly half of all positive screening tests are not appropriately evaluated. OBJECTIVES: We evaluated whether an electronic record intervention improved the follow-up of patients with a positive FOBT (FOBT+) result. DESIGN: We conducted a cluster randomized trial involving four Veteran's Affairs (VA) medical centers pair-matched by colonoscopy volume and randomized within the pair to receive the electronic intervention or usual care. PARTICIPANTS: All patients with FOBT+ results at participating facilities during a matched pre- and post-intervention time period. INTERVENTIONS: In the two intervention sites, an electronic consult that imported relevant clinical information was automatically submitted to the gastroenterology (GI) clinic for all FOBT+ patients at the time the result was recorded in the laboratory. In both intervention and control sites (usual care), PCPs continued to be notified of FOBT+ results in the usual manner MEASURES: Pre- and post-intervention changes in the proportion of FOBT+ patients having: (1) a GI consult or (2) a GI consult plus complete diagnostic evaluation (CDE) of the colon within 30, 90 and 180 days were compared across intervention and control sites. Log rank tests were used to determine statistical significance. RESULTS: The 30-, 90- and 180-day GI consult rates improved 21-33 % (p < 0.001) among intervention sites, but did not change in the usual care sites. Thirty-, 90- and 180-day CDE rates improved 9-31% (p < 0.03) in intervention sites, but did not significantly change in the usual care sites. Time to GI consult and CDE decreased significantly over time in the intervention sites (p < 0.001), but remained unchanged in the usual care sites. CONCLUSIONS: The relatively simple electronic intervention evaluated can significantly improve the follow-up of FOBT+ results. Interventions such as this could improve patient care and may be applicable to other practice settings, as well as other types of tests.
RCT Entities:
BACKGROUND: Four population-based studies of screening for CRC with fecal occult blood testing (FOBT) have shown that mortality can be significantly reduced. However, nearly half of all positive screening tests are not appropriately evaluated. OBJECTIVES: We evaluated whether an electronic record intervention improved the follow-up of patients with a positive FOBT (FOBT+) result. DESIGN: We conducted a cluster randomized trial involving four Veteran's Affairs (VA) medical centers pair-matched by colonoscopy volume and randomized within the pair to receive the electronic intervention or usual care. PARTICIPANTS: All patients with FOBT+ results at participating facilities during a matched pre- and post-intervention time period. INTERVENTIONS: In the two intervention sites, an electronic consult that imported relevant clinical information was automatically submitted to the gastroenterology (GI) clinic for all FOBT+ patients at the time the result was recorded in the laboratory. In both intervention and control sites (usual care), PCPs continued to be notified of FOBT+ results in the usual manner MEASURES: Pre- and post-intervention changes in the proportion of FOBT+ patients having: (1) a GI consult or (2) a GI consult plus complete diagnostic evaluation (CDE) of the colon within 30, 90 and 180 days were compared across intervention and control sites. Log rank tests were used to determine statistical significance. RESULTS: The 30-, 90- and 180-day GI consult rates improved 21-33 % (p < 0.001) among intervention sites, but did not change in the usual care sites. Thirty-, 90- and 180-day CDE rates improved 9-31% (p < 0.03) in intervention sites, but did not significantly change in the usual care sites. Time to GI consult and CDE decreased significantly over time in the intervention sites (p < 0.001), but remained unchanged in the usual care sites. CONCLUSIONS: The relatively simple electronic intervention evaluated can significantly improve the follow-up of FOBT+ results. Interventions such as this could improve patient care and may be applicable to other practice settings, as well as other types of tests.
Authors: Ronald E Myers; Barbara Turner; David Weinberg; Terry Hyslop; Walter W Hauck; Timothy Brigham; Todd Rothermel; James Grana; Neil Schlackman Journal: Prev Med Date: 2004-04 Impact factor: 4.018
Authors: Beverly B Green; Melissa L Anderson; Ching-Yun Wang; Sally W Vernon; Jessica Chubak; Richard T Meenan; Sharon Fuller Journal: J Am Board Fam Med Date: 2014 Nov-Dec Impact factor: 2.657
Authors: Michael K Dougherty; Alison T Brenner; Seth D Crockett; Shivani Gupta; Stephanie B Wheeler; Manny Coker-Schwimmer; Laura Cubillos; Teri Malo; Daniel S Reuland Journal: JAMA Intern Med Date: 2018-12-01 Impact factor: 21.873
Authors: Djenaba A Joseph; Reinier G S Meester; Ann G Zauber; Diane L Manninen; Linda Winges; Fred B Dong; Brandy Peaker; Marjolein van Ballegooijen Journal: Cancer Date: 2016-05-20 Impact factor: 6.860
Authors: Caroline E Sloan; Seetharam C Chadalavada; Tessa S Cook; Curtis P Langlotz; Mitchell D Schnall; Hanna M Zafar Journal: Acad Radiol Date: 2014-08-30 Impact factor: 3.173
Authors: Kaveh G Shojania; Alison Jennings; Alain Mayhew; Craig R Ramsay; Martin P Eccles; Jeremy Grimshaw Journal: Cochrane Database Syst Rev Date: 2009-07-08