April 03, 2024
2 min read
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Key takeaways:
- Approximately 48% of patients underwent a follow-up colonoscopy within 6 months of abnormal stool-based screening test.
- Black patients and those with Medicare or Medicaid had the lowest follow-up rates.
A quality performance measure that tracks follow-up colonoscopy rates within 6 months of an abnormal stool-based screening test was feasible and had a median reliability of 94.5% across health care organizations, according to researchers.
“Based on our previous work, we recognized a serious deficit in patients receiving the necessary follow-up after an abnormal stool-based screening test for colorectal cancer,” Elizabeth L. Ciemins, PhD, MPH, MA, senior vice president of research and analytics at the American Medical Group Association, told Healio. “Our accompanying qualitative research identified a lack of awareness in current rates of follow-up by primary care providers and others.”
Ciemins continued: “We wanted to explore one potential solution — a quality performance measure — that would bring this issue to the forefront and motivate providers and health systems to focus on improvement in follow-up.”
Using deidentified electronic health record data from the Optum Labs Data Warehouse (2016-2020), researchers conducted a retrospective quality improvement study to develop and test a measure for follow-up colonoscopy. The study population included 20,581 adults (mean age, 63.6 years; 51.4% women; 86% white) from 38 health care organizations who had an abnormal stool-based screening test result for CRC, with 2018 identified as the primary measurement year.
The primary outcome was follow-up colonoscopy rates within 6 months of an abnormal test, grouped by race, ethnicity, sex, insurance and type of test.
According to results in JAMA Network Open, a median of 47.9% of patients underwent a follow-up colonoscopy within 6 months, with a median follow-up of 53 days. Researchers noted “significant variation” between health care organizations, with performance ranging from 13.1% to 69.9%. Follow-up rates also differed across years and increased by approximately 33% between 2016 and 2019, indicating organizations can improve performance rates, and subsequently declined by 14% through 2020, likely because of the COVID-19 pandemic.
White patients had the highest rates of follow-up in 2018 (49%; 95% CI, 48.2-49.7) compared with Black (37.1%; 95% CI, 34.6-39.5) and Hispanic patients (38.4%; 95% CI, 34.6-42.1), as did those with commercial insurance (50.9%; 95% CI, 50-51.7) compared with Medicare (49.2%; 95% CI, 47.7-50.6) or Medicaid (39.2%; 95% CI, 36.6-42.1).
According to researchers, a quality performance measure that tracks rates of follow-up within 6 months had an overall median reliability of 94.5% across organizations (range, 74.3%-99.7%). By race, ethnicity and measurement year, reliability rates were 94.2% (79.5%-99.5%), 93.1% (86.7%-99.4%) and 99.3% (99.1%-99.4%), respectively.
“A quality performance measure — that might help increase follow-up rates and ultimately decrease cancer morbidity and save lives — is feasible and should be fully developed and implemented,” Ciemins said. “When a patient completes an initial stool-based screening test for colorectal cancer, the screening is not complete until either a negative screening test result is returned or the patient completes a colonoscopy.”
She continued: “Health systems need to focus on this complete process, including patient and provider education, streamlining workflows and care processes and having primary care work closely with gastroenterology to identify and provide follow-up for patients, as needed.”
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Sources/Disclosures
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Disclosures:
Ciemins reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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