Colorectal Cancer Testing in the National Veterans Health Administration

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2011 Sep 17

PMID 21922220

Citations 16

Authors

Millie D Long

Trang Lance

Douglas Robertson

Leila Kahwati

Linda Kinsinger

Deborah A Fisher

Affiliations

Soon will be listed here.

Abstract

Background: Colorectal cancer (CRC) screening is a priority for the Veteran's Health Administration (VHA). Optimizing fecal occult blood testing (FOBT) is integral to CRC screening in health care systems.

Aims: The purpose of this study was to characterize the utilization of CRC testing in a large integrated health care system (VHA), determine current rates of CRC testing by FOBT and examine factors associated with lack of FOBT card return.

Methods: The VHA Office of Quality and Performance (OQP) collected data from a national sample of Veterans from October 2008 to September 2009. Rates and modality of CRC testing for eligible Veterans were calculated. Among those offered FOBT, bivariate analyses were performed to describe population characteristics by FOBT return. Logistic regression was used to determine factors independently associated with lack of FOBT return.

Results: A total of 36,336 Veterans were included. On weighted analysis, 80.4% of Veterans received a form of CRC screening. The majority underwent colonoscopy in the prior 10 years (71.6%), followed by FOBT in the prior year (24.0%). A total of 31.0% did not return FOBT cards that were provided. Factors associated with a lack of FOBT return included: younger age, female gender, non-Caucasian race, living in the Northeast, current smoking and lack of influenza vaccination.

Conclusions: Overall rates of CRC screening in VHA are high. Systems-based practices within VHA likely play a role in successful CRC screening. CRC screening is most often via colonoscopy, followed by FOBT. Characteristics associated with non-adherence with FOBT may inform future quality improvement initiatives in health care systems.

Citing Articles

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References

El-Serag H, Petersen L, Hampel H, Richardson P, Cooper G . The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs. Arch Intern Med. 2006; 166(20):2202-8. DOI: 10.1001/archinte.166.20.2202. View

. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008; 149(9):627-37. DOI: 10.7326/0003-4819-149-9-200811040-00243. View

Smith R, Cokkinides V, Brooks D, Saslow D, Brawley O . Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010; 60(2):99-119. DOI: 10.3322/caac.20063. View

Kizer K, Demakis J, Feussner J . Reinventing VA health care: systematizing quality improvement and quality innovation. Med Care. 2000; 38(6 Suppl 1):I7-16. View

. Use of colorectal cancer tests--United States, 2002, 2004, and 2006. MMWR Morb Mortal Wkly Rep. 2008; 57(10):253-8. View

Lee J, Reis V, Liu S, Conn L, Groessl E, Ganiats T . Improving fecal occult blood testing compliance using a mailed educational reminder. J Gen Intern Med. 2009; 24(11):1192-7. PMC: 2771232. DOI: 10.1007/s11606-009-1087-5. View

Trivedi A, Matula S, Miake-Lye I, Glassman P, Shekelle P, Asch S . Systematic review: comparison of the quality of medical care in Veterans Affairs and non-Veterans Affairs settings. Med Care. 2010; 49(1):76-88. DOI: 10.1097/MLR.0b013e3181f53575. View

Halpern J . The measurement of quality of care in the Veterans Health Administration. Med Care. 1996; 34(3 Suppl):MS55-68. DOI: 10.1097/00005650-199603001-00006. View

Von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W . Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol. 2011; 40(3):712-8. DOI: 10.1093/ije/dyr008. View

10.

Greiner K, James A, Born W, Hall S, Engelman K, Okuyemi K . Predictors of fecal occult blood test (FOBT) completion among low-income adults. Prev Med. 2005; 41(2):676-84. DOI: 10.1016/j.ypmed.2004.12.010. View

11.

Asch S, McGlynn E, Hogan M, Hayward R, Shekelle P, Rubenstein L . Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004; 141(12):938-45. DOI: 10.7326/0003-4819-141-12-200412210-00010. View

12.

Partin M, Grill J, Noorbaloochi S, Powell A, Burgess D, Vernon S . Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans. Cancer Epidemiol Biomarkers Prev. 2008; 17(4):768-76. DOI: 10.1158/1055-9965.EPI-07-0759. View

13.

Jackson G, Powell A, Ordin D, Schlosser J, Murawsky J, Hersh J . Developing and sustaining quality improvement partnerships in the VA: the Colorectal Cancer Care Collaborative. J Gen Intern Med. 2010; 25 Suppl 1:38-43. PMC: 2806962. DOI: 10.1007/s11606-009-1155-x. View

14.

Zauber A, Lansdorp-Vogelaar I, Knudsen A, Wilschut J, van Ballegooijen M, M Kuntz K . Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008; 149(9):659-69. PMC: 2731975. DOI: 10.7326/0003-4819-149-9-200811040-00244. View

15.

Jemal A, Siegel R, Xu J, Ward E . Cancer statistics, 2010. CA Cancer J Clin. 2010; 60(5):277-300. DOI: 10.3322/caac.20073. View

16.

Levin B, Lieberman D, McFarland B, Smith R, Brooks D, Andrews K . Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008; 58(3):130-60. DOI: 10.3322/CA.2007.0018. View

17.

Fisher D, Voils C, Coffman C, Grubber J, Dudley T, Vernon S . Validation of a questionnaire to assess self-reported colorectal cancer screening status using face-to-face administration. Dig Dis Sci. 2008; 54(6):1297-306. PMC: 2754798. DOI: 10.1007/s10620-008-0471-z. View