Elaine C Khoong1,2, Natalie A Rivadeneira3,4, Lucia Pacca3,4, Dean Schillinger3,4, David Lown5, Palav Babaria3,6, Neha Gupta6, Rajiv Pramanik7, Helen Tran8,9, Tyler Whitezell10, Ma Somsouk4,11, Urmimala Sarkar3,4. 1. Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA. Elaine.Khoong@ucsf.edu. 2. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. Elaine.Khoong@ucsf.edu. 3. Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA. 4. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. 5. California Health Care Safety Net Institute, Oakland, CA, USA. 6. Alameda Health System, Oakland, CA, USA. 7. Office of Informatics & Technology and Department of Emergency Medicine, Contra Costa Health Services, Martinez, CA, USA. 8. Department of Family Medicine, Charles R. Drew University College of Medicine, Los Angeles, CA, USA. 9. Department of Health Services at Los Angeles County, Los Angeles, CA, USA. 10. Kern Medical, Bakersfield, CA, USA. 11. Division of Gastroenterology, Department of Medicine, UCSF, San Francisco, CA, USA.
Abstract
BACKGROUND: Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist. OBJECTIVE: This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. DESIGN: We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test. MAIN MEASURES: Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram. KEY RESULTS: Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy. CONCLUSION: Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system-level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system-level interventions can be evaluated and disseminated.
BACKGROUND: Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist. OBJECTIVE: This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. DESIGN: We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test. MAIN MEASURES: Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram. KEY RESULTS: Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy. CONCLUSION: Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system-level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system-level interventions can be evaluated and disseminated.
Authors: Rachel B Issaka; Maneesh H Singh; Sachiko M Oshima; Victoria J Laleau; Carly D Rachocki; Ellen H Chen; Lukejohn W Day; Urmimala Sarkar; Ma Somsouk Journal: Am J Gastroenterol Date: 2016-12-13 Impact factor: 10.864
Authors: Anne Marie McCarthy; Jane J Kim; Elisabeth F Beaber; Yingye Zheng; Andrea Burnett-Hartman; Jessica Chubak; Nirupa R Ghai; Dale McLerran; Nancy Breen; Emily F Conant; Berta M Geller; Beverly B Green; Carrie N Klabunde; Stephen Inrig; Celette Sugg Skinner; Virginia P Quinn; Jennifer S Haas; Mitchell Schnall; Carolyn M Rutter; William E Barlow; Douglas A Corley; Katrina Armstrong; Chyke A Doubeni Journal: Am J Prev Med Date: 2016-04-28 Impact factor: 5.043
Authors: Yinzhi Lai; Chun Wang; Jesse M Civan; Juan P Palazzo; Zhong Ye; Terry Hyslop; Jianqing Lin; Ronald E Myers; Bingshan Li; Binghua Jiang; Ashwin Sama; Jinliang Xing; Hushan Yang Journal: Gastroenterology Date: 2016-02-02 Impact factor: 22.682
Authors: Julia Adler-Milstein; A Jay Holmgren; Peter Kralovec; Chantal Worzala; Talisha Searcy; Vaishali Patel Journal: J Am Med Inform Assoc Date: 2017-11-01 Impact factor: 4.497