BACKGROUND: Inappropriate use of colorectal cancer (CRC) screening procedures can inflate healthcare costs and increase medical risk. Little is known about the prevalence or causes of inappropriate CRC screening. OBJECTIVE: Our aim was to estimate the prevalence of potentially inappropriate CRC screening, and its association with patient and facility characteristics in the Veterans Health Administration (VHA) . DESIGN AND PARTICIPANTS: We conducted a cross-sectional study of all VHA patients aged 50 years and older who completed a fecal occult blood test (FOBT) or a screening colonoscopy between 1 October 2009 and 31 December 2011 (n = 1,083,965). MAIN MEASURES: Measures included: proportion of patients whose test was classified as potentially inappropriate; associations between potentially inappropriate screening and patient demographic and health characteristics, facility complexity, CRC screening rates, dependence on FOBT, and CRC clinical reminder attributes. KEY RESULTS: Of 901,292 FOBT cases, 26.1 % were potentially inappropriate (13.9 % not due, 7.8 % limited life expectancy, 11.0 % receiving FOBT when colonoscopy was indicated). Of 134,335 screening colonoscopies, 14.2 % were potentially inappropriate (10.4 % not due, 4.4 % limited life expectancy). Each additional 10 years of patient age was associated with an increased likelihood of undergoing potentially inappropriate screening (ORs = 1.60 to 1.83 depending on screening mode). Compared to facilities scoring in the bottom third on a measure of reliance on FOBT (versus screening colonoscopy), facilities scoring in the top third were less likely to conduct potentially inappropriate FOBTs (OR = 0.,78) but more likely to conduct potentially inappropriate colonoscopies (OR = 2.20). Potentially inappropriate colonoscopies were less likely to be conducted at facilities where primary care providers were assigned partial responsibility (OR = 0.74) or full responsibility (OR = 0.73) for completing the CRC clinical reminder. CONCLUSIONS: A substantial number of VHA CRC screening tests are potentially inappropriate. Establishing processes that enforce appropriate screening intervals, triage patients with limited life expectancies, and discourage the use of FOBTs when a colonoscopy is indicated may reduce inappropriate testing.
BACKGROUND: Inappropriate use of colorectal cancer (CRC) screening procedures can inflate healthcare costs and increase medical risk. Little is known about the prevalence or causes of inappropriate CRC screening. OBJECTIVE: Our aim was to estimate the prevalence of potentially inappropriate CRC screening, and its association with patient and facility characteristics in the Veterans Health Administration (VHA) . DESIGN AND PARTICIPANTS: We conducted a cross-sectional study of all VHA patients aged 50 years and older who completed a fecal occult blood test (FOBT) or a screening colonoscopy between 1 October 2009 and 31 December 2011 (n = 1,083,965). MAIN MEASURES: Measures included: proportion of patients whose test was classified as potentially inappropriate; associations between potentially inappropriate screening and patient demographic and health characteristics, facility complexity, CRC screening rates, dependence on FOBT, and CRC clinical reminder attributes. KEY RESULTS: Of 901,292 FOBT cases, 26.1 % were potentially inappropriate (13.9 % not due, 7.8 % limited life expectancy, 11.0 % receiving FOBT when colonoscopy was indicated). Of 134,335 screening colonoscopies, 14.2 % were potentially inappropriate (10.4 % not due, 4.4 % limited life expectancy). Each additional 10 years of patient age was associated with an increased likelihood of undergoing potentially inappropriate screening (ORs = 1.60 to 1.83 depending on screening mode). Compared to facilities scoring in the bottom third on a measure of reliance on FOBT (versus screening colonoscopy), facilities scoring in the top third were less likely to conduct potentially inappropriate FOBTs (OR = 0.,78) but more likely to conduct potentially inappropriate colonoscopies (OR = 2.20). Potentially inappropriate colonoscopies were less likely to be conducted at facilities where primary care providers were assigned partial responsibility (OR = 0.74) or full responsibility (OR = 0.73) for completing the CRC clinical reminder. CONCLUSIONS: A substantial number of VHA CRC screening tests are potentially inappropriate. Establishing processes that enforce appropriate screening intervals, triage patients with limited life expectancies, and discourage the use of FOBTs when a colonoscopy is indicated may reduce inappropriate testing.
Authors: Melissa R Partin; Adam A Powell; Ann Bangerter; Krysten Halek; James F Burgess; Deborah A Fisher; David B Nelson Journal: J Gen Intern Med Date: 2012-07-19 Impact factor: 5.128
Authors: Melissa R Partin; Siamak Noorbaloochi; Joseph Grill; Diana J Burgess; Michelle van Ryn; Deborah A Fisher; Joan M Griffin; Adam A Powell; Krysten Halek; Ann Bangerter; Sally W Vernon Journal: Cancer Causes Control Date: 2010-04-24 Impact factor: 2.506
Authors: Ellen M Janssen; Craig E Pollack; Cynthia Boyd; John F P Bridges; Qian-Li Xue; Antonio C Wolff; Nancy L Schoenborn Journal: Med Decis Making Date: 2019-06-21 Impact factor: 2.583
Authors: Nancy L Schoenborn; Jin Huang; Orla C Sheehan; Jennifer L Wolff; David L Roth; Cynthia M Boyd Journal: J Gen Intern Med Date: 2018-11-06 Impact factor: 5.128
Authors: Nancy L Schoenborn; Norah L Crossnohere; Ellen M Janssen; Craig E Pollack; Cynthia M Boyd; Antonio C Wolff; Qian-Li Xue; Jacqueline Massare; Marcela Blinka; John F P Bridges Journal: J Gen Intern Med Date: 2019-08-26 Impact factor: 5.128
Authors: Sameer D Saini; Adam A Powell; Jason A Dominitz; Deborah A Fisher; Joseph Francis; Linda Kinsinger; Kathleen S Pittman; Philip Schoenfeld; Stephanie E Moser; Sandeep Vijan; Eve A Kerr Journal: J Gen Intern Med Date: 2016-04 Impact factor: 5.128
Authors: Zachary Predmore; Jean Pannikottu; Ritu Sharma; Monica Tung; Stephanie Nothelle; Jodi B Segal Journal: Am J Med Qual Date: 2018-03-16 Impact factor: 1.852