Patterns and predictors or repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States

Amit G. Singal, Douglas A. Corley, Aruna Kamineni, Michael Garcia, Yingye Zheng, Paul V. Doria-Rose, Virginia P. Quinn, Christopher D. Jensen, Jessica Chubak, Jasmin Tiro, Chyke A. Doubeni, Nirupa R. Ghai, Celette Sugg Skinner, Karen Wernli, Ethan A. Halm

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVES: Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study’s objective was to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac FOBT (gFOBT) or fecal immunochemical test (FIT). METHODS: We performed a multi-center retrospective cohort study among people who completed a FOBT between January 2010 and December 2011 to characterize repeat screening patterns over the subsequent 3 years. We studied at 4 large health care delivery systems in the United States. Logistic regression analyses were used to identify factors associated with repeat screening patterns. We included individuals aged 50–71 years who completed an index FOBT and had at least 3 years of follow-up. We excluded people with a history of CRC, colonoscopy within 10 years or flexible sigmoidoscopy within 5 years before the index test, or positive index stool test. Consistent screening was defined as repeat FOBT within every 15 months and inconsistent screening as repeat testing at least once during follow-up but less than consistent screening. RESULTS: Among 959,857 eligible patients who completed an index FIT or gFOBT, 344,103 had three years of follow-up and met inclusion criteria. Of these, 46.6% had consistent screening, 43.4% inconsistent screening, and 10% had no repeat screening during follow-up. Screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Higher consistent screening proportions were observed in health systems with screening outreach and in-reach programs, whereas the safety-net health system, which uses opportunistic clinic-based screening, had the lowest consistent screening. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities. CONCLUSIONS: Adherence with annual FOBT screening is highly variable across healthcare delivery systems. Settings with more organized screening programs performed better than those with opportunistic screening, but evidence-based interventions are needed to improve CRC screening adherence in all settings.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAmerican Journal of Gastroenterology
DOIs
StateAccepted/In press - Feb 27 2018

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Occult Blood
Hematologic Tests
Delivery of Health Care
Guaiac
Colorectal Neoplasms
Early Detection of Cancer
Sigmoidoscopy
Health
Colonoscopy
Comorbidity
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Safety

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Patterns and predictors or repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States. / Singal, Amit G.; Corley, Douglas A.; Kamineni, Aruna; Garcia, Michael; Zheng, Yingye; Doria-Rose, Paul V.; Quinn, Virginia P.; Jensen, Christopher D.; Chubak, Jessica; Tiro, Jasmin; Doubeni, Chyke A.; Ghai, Nirupa R.; Skinner, Celette Sugg; Wernli, Karen; Halm, Ethan A.

In: American Journal of Gastroenterology, 27.02.2018, p. 1-9.

Research output: Contribution to journalArticle

Singal, Amit G. ; Corley, Douglas A. ; Kamineni, Aruna ; Garcia, Michael ; Zheng, Yingye ; Doria-Rose, Paul V. ; Quinn, Virginia P. ; Jensen, Christopher D. ; Chubak, Jessica ; Tiro, Jasmin ; Doubeni, Chyke A. ; Ghai, Nirupa R. ; Skinner, Celette Sugg ; Wernli, Karen ; Halm, Ethan A. / Patterns and predictors or repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States. In: American Journal of Gastroenterology. 2018 ; pp. 1-9.
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abstract = "OBJECTIVES: Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study’s objective was to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac FOBT (gFOBT) or fecal immunochemical test (FIT). METHODS: We performed a multi-center retrospective cohort study among people who completed a FOBT between January 2010 and December 2011 to characterize repeat screening patterns over the subsequent 3 years. We studied at 4 large health care delivery systems in the United States. Logistic regression analyses were used to identify factors associated with repeat screening patterns. We included individuals aged 50–71 years who completed an index FOBT and had at least 3 years of follow-up. We excluded people with a history of CRC, colonoscopy within 10 years or flexible sigmoidoscopy within 5 years before the index test, or positive index stool test. Consistent screening was defined as repeat FOBT within every 15 months and inconsistent screening as repeat testing at least once during follow-up but less than consistent screening. RESULTS: Among 959,857 eligible patients who completed an index FIT or gFOBT, 344,103 had three years of follow-up and met inclusion criteria. Of these, 46.6{\%} had consistent screening, 43.4{\%} inconsistent screening, and 10{\%} had no repeat screening during follow-up. Screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3{\%} and no repeat screening proportions ranging from 6.9 to 42.8{\%}. Higher consistent screening proportions were observed in health systems with screening outreach and in-reach programs, whereas the safety-net health system, which uses opportunistic clinic-based screening, had the lowest consistent screening. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities. CONCLUSIONS: Adherence with annual FOBT screening is highly variable across healthcare delivery systems. Settings with more organized screening programs performed better than those with opportunistic screening, but evidence-based interventions are needed to improve CRC screening adherence in all settings.",
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T1 - Patterns and predictors or repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States

AU - Singal, Amit G.

AU - Corley, Douglas A.

AU - Kamineni, Aruna

AU - Garcia, Michael

AU - Zheng, Yingye

AU - Doria-Rose, Paul V.

AU - Quinn, Virginia P.

AU - Jensen, Christopher D.

AU - Chubak, Jessica

AU - Tiro, Jasmin

AU - Doubeni, Chyke A.

AU - Ghai, Nirupa R.

AU - Skinner, Celette Sugg

AU - Wernli, Karen

AU - Halm, Ethan A.

PY - 2018/2/27

Y1 - 2018/2/27

N2 - OBJECTIVES: Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study’s objective was to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac FOBT (gFOBT) or fecal immunochemical test (FIT). METHODS: We performed a multi-center retrospective cohort study among people who completed a FOBT between January 2010 and December 2011 to characterize repeat screening patterns over the subsequent 3 years. We studied at 4 large health care delivery systems in the United States. Logistic regression analyses were used to identify factors associated with repeat screening patterns. We included individuals aged 50–71 years who completed an index FOBT and had at least 3 years of follow-up. We excluded people with a history of CRC, colonoscopy within 10 years or flexible sigmoidoscopy within 5 years before the index test, or positive index stool test. Consistent screening was defined as repeat FOBT within every 15 months and inconsistent screening as repeat testing at least once during follow-up but less than consistent screening. RESULTS: Among 959,857 eligible patients who completed an index FIT or gFOBT, 344,103 had three years of follow-up and met inclusion criteria. Of these, 46.6% had consistent screening, 43.4% inconsistent screening, and 10% had no repeat screening during follow-up. Screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Higher consistent screening proportions were observed in health systems with screening outreach and in-reach programs, whereas the safety-net health system, which uses opportunistic clinic-based screening, had the lowest consistent screening. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities. CONCLUSIONS: Adherence with annual FOBT screening is highly variable across healthcare delivery systems. Settings with more organized screening programs performed better than those with opportunistic screening, but evidence-based interventions are needed to improve CRC screening adherence in all settings.

AB - OBJECTIVES: Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study’s objective was to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac FOBT (gFOBT) or fecal immunochemical test (FIT). METHODS: We performed a multi-center retrospective cohort study among people who completed a FOBT between January 2010 and December 2011 to characterize repeat screening patterns over the subsequent 3 years. We studied at 4 large health care delivery systems in the United States. Logistic regression analyses were used to identify factors associated with repeat screening patterns. We included individuals aged 50–71 years who completed an index FOBT and had at least 3 years of follow-up. We excluded people with a history of CRC, colonoscopy within 10 years or flexible sigmoidoscopy within 5 years before the index test, or positive index stool test. Consistent screening was defined as repeat FOBT within every 15 months and inconsistent screening as repeat testing at least once during follow-up but less than consistent screening. RESULTS: Among 959,857 eligible patients who completed an index FIT or gFOBT, 344,103 had three years of follow-up and met inclusion criteria. Of these, 46.6% had consistent screening, 43.4% inconsistent screening, and 10% had no repeat screening during follow-up. Screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Higher consistent screening proportions were observed in health systems with screening outreach and in-reach programs, whereas the safety-net health system, which uses opportunistic clinic-based screening, had the lowest consistent screening. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities. CONCLUSIONS: Adherence with annual FOBT screening is highly variable across healthcare delivery systems. Settings with more organized screening programs performed better than those with opportunistic screening, but evidence-based interventions are needed to improve CRC screening adherence in all settings.

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