Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study.
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| Title: | Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study. |
|---|---|
| Authors: | Selby, K., Jensen, C.D., Zhao, W.K., Lee, J.K., Slam, A., Schottinger, J.E., Bacchetti, P., Levin, T.R., Corley, D.A. |
| Publication Year: | 2025 |
| Collection: | Université de Lausanne (UNIL): Serval - Serveur académique lausannois |
| Subject Terms: | Aftercare/organization & administration, Aged, Colonoscopy/statistics & numerical data, Colorectal Neoplasms/diagnosis, Comorbidity, Early Detection of Cancer/methods, Early Detection of Cancer/statistics & numerical data, Female, Gastroenterologists/organization & administration, Humans, Male, Mass Screening/organization & administration, Middle Aged, Occult Blood, Patient Acceptance of Health Care/psychology, Patient Acceptance of Health Care/statistics & numerical data, Primary Health Care/organization & administration, Program Evaluation, Qualitative Research, Retrospective Studies |
| Description: | The effectiveness of fecal immunochemical test (FIT) screening for colorectal cancer depends on timely colonoscopy follow-up of positive tests, although limited data exist regarding effective system-level strategies for improving follow-up rates. Using a mixed-methods design (qualitative and quantitative), we first identified system-level strategies that were implemented for improving timely follow-up after a positive FIT test in a large community-based setting between 2006 and 2016. We then evaluated changes in time to colonoscopy among FIT-positive patients across 3 periods during the study interval, controlling for screening participant age, sex, race/ethnicity, comorbidity, FIT date, and previous screening history. Implemented strategies over the study period included setting a goal of colonoscopy follow-up within 30 days of a positive FIT, tracking FIT-positive patients, early telephone contact to directly schedule follow-up colonoscopies, assigning the responsibility for follow-up tracking and scheduling to gastroenterology departments (vs primary care), and increasing colonoscopy capacity. Among 160,051 patients who had a positive FIT between 2006 and 2016, 126,420 (79%) had a follow-up colonoscopy within 180 days, including 67% in 2006-2008, 79% in 2009-2012, and 83% in 2013-2016 (P < 0.001). Follow-up within 180 days in 2016 varied moderately across service areas, between 72% (95% CI 70-75) and 88% (95% CI 86-91), but there were no obvious differences in the pattern of strategies implemented in higher- vs lower-performing service areas. The implementation of system-level strategies coincided with substantial improvements in timely colonoscopy follow-up after a positive FIT. Intervention studies are needed to identify the most effective strategies for promoting timely follow-up. |
| Document Type: | article in journal/newspaper |
| File Description: | application/pdf |
| Language: | English |
| ISSN: | 2155-384X 30829917 |
| Relation: | Clinical and Translational Gastroenterology; https://iris.unil.ch/handle/iris/35561; serval:BIB_3A59A41398A8; 000462446900001 |
| DOI: | 10.14309/ctg.0000000000000010 |
| Availability: | https://iris.unil.ch/handle/iris/35561 https://doi.org/10.14309/ctg.0000000000000010 |
| Accession Number: | edsbas.F5E6DA3D |
| Database: | BASE |
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| Header | DbId: edsbas DbLabel: BASE An: edsbas.F5E6DA3D RelevancyScore: 939 AccessLevel: 3 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 939.3056640625 |
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| Items | – Name: Title Label: Title Group: Ti Data: Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Selby%2C+K%2E%22">Selby, K.</searchLink><br /><searchLink fieldCode="AR" term="%22Jensen%2C+C%2ED%2E%22">Jensen, C.D.</searchLink><br /><searchLink fieldCode="AR" term="%22Zhao%2C+W%2EK%2E%22">Zhao, W.K.</searchLink><br /><searchLink fieldCode="AR" term="%22Lee%2C+J%2EK%2E%22">Lee, J.K.</searchLink><br /><searchLink fieldCode="AR" term="%22Slam%2C+A%2E%22">Slam, A.</searchLink><br /><searchLink fieldCode="AR" term="%22Schottinger%2C+J%2EE%2E%22">Schottinger, J.E.</searchLink><br /><searchLink fieldCode="AR" term="%22Bacchetti%2C+P%2E%22">Bacchetti, P.</searchLink><br /><searchLink fieldCode="AR" term="%22Levin%2C+T%2ER%2E%22">Levin, T.R.</searchLink><br /><searchLink fieldCode="AR" term="%22Corley%2C+D%2EA%2E%22">Corley, D.A.</searchLink> – Name: DatePubCY Label: Publication Year Group: Date Data: 2025 – Name: Subset Label: Collection Group: HoldingsInfo Data: Université de Lausanne (UNIL): Serval - Serveur académique lausannois – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Aftercare%2Forganization+%26+administration%22">Aftercare/organization & administration</searchLink><br /><searchLink fieldCode="DE" term="%22Aged%22">Aged</searchLink><br /><searchLink fieldCode="DE" term="%22Colonoscopy%2Fstatistics+%26+numerical+data%22">Colonoscopy/statistics & numerical data</searchLink><br /><searchLink fieldCode="DE" term="%22Colorectal+Neoplasms%2Fdiagnosis%22">Colorectal Neoplasms/diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Detection+of+Cancer%2Fmethods%22">Early Detection of Cancer/methods</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Detection+of+Cancer%2Fstatistics+%26+numerical+data%22">Early Detection of Cancer/statistics & numerical data</searchLink><br /><searchLink fieldCode="DE" term="%22Female%22">Female</searchLink><br /><searchLink fieldCode="DE" term="%22Gastroenterologists%2Forganization+%26+administration%22">Gastroenterologists/organization & administration</searchLink><br /><searchLink fieldCode="DE" term="%22Humans%22">Humans</searchLink><br /><searchLink fieldCode="DE" term="%22Male%22">Male</searchLink><br /><searchLink fieldCode="DE" term="%22Mass+Screening%2Forganization+%26+administration%22">Mass Screening/organization & administration</searchLink><br /><searchLink fieldCode="DE" term="%22Middle+Aged%22">Middle Aged</searchLink><br /><searchLink fieldCode="DE" term="%22Occult+Blood%22">Occult Blood</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+Acceptance+of+Health+Care%2Fpsychology%22">Patient Acceptance of Health Care/psychology</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+Acceptance+of+Health+Care%2Fstatistics+%26+numerical+data%22">Patient Acceptance of Health Care/statistics & numerical data</searchLink><br /><searchLink fieldCode="DE" term="%22Primary+Health+Care%2Forganization+%26+administration%22">Primary Health Care/organization & administration</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Evaluation%22">Program Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Qualitative+Research%22">Qualitative Research</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+Studies%22">Retrospective Studies</searchLink> – Name: Abstract Label: Description Group: Ab Data: The effectiveness of fecal immunochemical test (FIT) screening for colorectal cancer depends on timely colonoscopy follow-up of positive tests, although limited data exist regarding effective system-level strategies for improving follow-up rates. Using a mixed-methods design (qualitative and quantitative), we first identified system-level strategies that were implemented for improving timely follow-up after a positive FIT test in a large community-based setting between 2006 and 2016. We then evaluated changes in time to colonoscopy among FIT-positive patients across 3 periods during the study interval, controlling for screening participant age, sex, race/ethnicity, comorbidity, FIT date, and previous screening history. Implemented strategies over the study period included setting a goal of colonoscopy follow-up within 30 days of a positive FIT, tracking FIT-positive patients, early telephone contact to directly schedule follow-up colonoscopies, assigning the responsibility for follow-up tracking and scheduling to gastroenterology departments (vs primary care), and increasing colonoscopy capacity. Among 160,051 patients who had a positive FIT between 2006 and 2016, 126,420 (79%) had a follow-up colonoscopy within 180 days, including 67% in 2006-2008, 79% in 2009-2012, and 83% in 2013-2016 (P < 0.001). Follow-up within 180 days in 2016 varied moderately across service areas, between 72% (95% CI 70-75) and 88% (95% CI 86-91), but there were no obvious differences in the pattern of strategies implemented in higher- vs lower-performing service areas. The implementation of system-level strategies coincided with substantial improvements in timely colonoscopy follow-up after a positive FIT. Intervention studies are needed to identify the most effective strategies for promoting timely follow-up. – Name: TypeDocument Label: Document Type Group: TypDoc Data: article in journal/newspaper – Name: Format Label: File Description Group: SrcInfo Data: application/pdf – Name: Language Label: Language Group: Lang Data: English – Name: ISSN Label: ISSN Group: ISSN Data: 2155-384X<br />30829917 – Name: NoteTitleSource Label: Relation Group: SrcInfo Data: Clinical and Translational Gastroenterology; https://iris.unil.ch/handle/iris/35561; serval:BIB_3A59A41398A8; 000462446900001 – Name: DOI Label: DOI Group: ID Data: 10.14309/ctg.0000000000000010 – Name: URL Label: Availability Group: URL Data: https://iris.unil.ch/handle/iris/35561<br />https://doi.org/10.14309/ctg.0000000000000010 – Name: AN Label: Accession Number Group: ID Data: edsbas.F5E6DA3D |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.14309/ctg.0000000000000010 Languages: – Text: English Subjects: – SubjectFull: Aftercare/organization & administration Type: general – SubjectFull: Aged Type: general – SubjectFull: Colonoscopy/statistics & numerical data Type: general – SubjectFull: Colorectal Neoplasms/diagnosis Type: general – SubjectFull: Comorbidity Type: general – SubjectFull: Early Detection of Cancer/methods Type: general – SubjectFull: Early Detection of Cancer/statistics & numerical data Type: general – SubjectFull: Female Type: general – SubjectFull: Gastroenterologists/organization & administration Type: general – SubjectFull: Humans Type: general – SubjectFull: Male Type: general – SubjectFull: Mass Screening/organization & administration Type: general – SubjectFull: Middle Aged Type: general – SubjectFull: Occult Blood Type: general – SubjectFull: Patient Acceptance of Health Care/psychology Type: general – SubjectFull: Patient Acceptance of Health Care/statistics & numerical data Type: general – SubjectFull: Primary Health Care/organization & administration Type: general – SubjectFull: Program Evaluation Type: general – SubjectFull: Qualitative Research Type: general – SubjectFull: Retrospective Studies Type: general Titles: – TitleFull: Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Selby, K. – PersonEntity: Name: NameFull: Jensen, C.D. – PersonEntity: Name: NameFull: Zhao, W.K. – PersonEntity: Name: NameFull: Lee, J.K. – PersonEntity: Name: NameFull: Slam, A. – PersonEntity: Name: NameFull: Schottinger, J.E. – PersonEntity: Name: NameFull: Bacchetti, P. – PersonEntity: Name: NameFull: Levin, T.R. – PersonEntity: Name: NameFull: Corley, D.A. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 2155384X – Type: issn-print Value: 30829917 – Type: issn-locals Value: edsbas |
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