Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems

Abstract

Background: To reduce colorectal cancer mortality, positive fecal blood tests must be followed by colonoscopy.

Methods: We identified 62,384 individuals ages 50 to 89 years with a positive fecal blood test between January 1, 2011 and December 31, 2012 in four health care systems within the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We estimated the probability of follow-up colonoscopy and 95% confidence intervals (CI) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. HRs and 95% CIs were estimated from multivariate Cox proportional hazards models.

Results: Most patients who received a colonoscopy did so within 6 months of their positive fecal blood test, although follow-up rates varied across health care systems (P <0.001). Median days to colonoscopy ranged from 41 (95% CI, 40-41) to 174 (95% CI, 123-343); percent followed-up by 12 months ranged from 58.1% (95% CI, 51.6%-63.7%) to 83.8% (95% CI, 83.4%-84.3%) and differences across health care systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower follow-up rates.

Conclusion: Individual characteristics and health care system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across health care systems, but proportions of patients receiving follow-up varied. These findings suggest that there is room to improve follow-up of positive colorectal cancer screening tests.

Impact: Understanding the timing of colonoscopy after positive fecal blood tests and characteristics associated with lack of follow-up may inform future efforts to improve follow-up.

Figure 1

Time to follow-up colonoscopy after positive fecal occult blood test, by PROSPR healthcare system, 2011–2012 (GH: Group Health; KPNC: Kaiser Permanente Northern California; KPSC: Kaiser Permanente Southern California; PHHS-UTSW: Parkland Health and Hospital System – University of Texas Southwestern Medical Center; PROSPR: Population-Based Research Optimizing Screening through Personalized Regimens)