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BACKGROUND/RATIONALE:
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Results from randomized clinical trials and intervention studies have suggested that implementation of a CRC screening program for men and women over age 50 results in reduced CRC mortality. However, for this reduction to be fully realized, it is imperative that all positive screening tests are followed by complete diagnostic evaluation. Numerous intervention programs have been used to improve initial CRC screening rates, but data indicate that outside the research setting, less than half of patients with a positive fecal occult blood test (FOBT) screening result undergo CDE. To test a method of improving follow-up of positive FOBT screening tests, we have developed a program that provides automatic referral to GI of patients with positive FOBT's and are testing it in a randomized clinical trial involving 7 VA sites with a pilot study ongoing in Portland.
OBJECTIVE(S):
1.To implement an electronic CRC screening event notification system intervention to improve complete evaluation of patients with a positive FOBT at four of eight VAMCs randomized to this intervention vs usual care.
2.To conduct a qualitative evaluation to identify implementation barriers and facilitators, and to guide modifications of the CRC-ENS.
3.To conduct an outcome evaluation to determine the effectiveness of the intervention to:
a. increase the proportion of patients with a positive FOBT receiving CDE
b. reduce the time-lag between notification of a positive FOBT result and scheduling of a follow-up endoscopic procedure
4. To improve patient compliance with follow-up recommendations through a combined scheduling/motivational telephone contact.
5. To assess VA primary care providers' knowledge, beliefs, attitudes and practices regarding FOBT screening and follow-up.
METHODS:
The CRC-ENS intervention employs a relatively simple alteration to the current electronic mechanism for notifying the primary care provider (PCP) of when a positive FOBT is recorded. With the CRC-ENS, this notification will be forwarded to the gastroenterology (GI) clinic as well as the PCP. This notification at the GI clinic will set off a cascade of events that would normally only be triggered by a consult request from the PCP. In this translation study, eight participating VHA sites have been randomly assigned to either the CRC-ENS intervention or comparison group. The proposed project will take two years to complete. During the first project year, the participating sites will be recruited and randomized. Pre-intervention change of awareness strategies will be initiated at all intervention sites. The CRC-ENS intervention will be implemented in the second project year, and formative evaluation (including two sets of focus groups) will be carried out throughout the intervention period. Post-intervention data collection, outcome evaluation and dissemination of results will be carried out in months 36-42.
FINDINGS/RESULTS:
The Portland VAMC is the pilot site and not included in the randomization. "Rollout" of the Portland Pilot was May 2, 2005. Staff tracks consult screen problems and reports them to the CPRS Information Tech. We meet with GI and PCP to identify problems with the system.
IMPACT:
The long-term objective of this project is to reduce colorectal cancer morbidity and mortality by improving adherence to best practice early detection procedures. The immediate objective is to implement and evaluate a system change intervention designed to facilitate complete diagnostic evaluation of patients with positive FOBT results.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Treatment
Keywords:
Cancer
MeSH Terms:
Guidelines
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