1043. Is Colorectal Cancer Screening Penetration an Adequate Quality Measure?
David A Etzioni, MD, MSHS, VA Greater Los Angeles HSR&D Center of Excellence and UCLA Clinical Scholars Program, SM Asch, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Medicine and RAND Corporation, LV Rubenstein, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Medicine and RAND Corporation, ML Lee, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Public Health, CY Ko, UCLA School of Medicine, RH Brook, UCLA School of Medicine and RAND Corporation, PH Parkerton, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Public Health, L Soban, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Public Health, EM Yano, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Public Health

Objectives: As evidence mounts for effectiveness, an increasing proportion of the US population undergoes colorectal cancer screening. However, relatively little is known about rates of follow-up after abnormal results from initial screening tests. This study examines patterns of colorectal cancer screening and follow-up within the nation's largest integrated health care system, the Veterans Health Administration (VA).

Methods: We obtained information about patients who received colorectal cancer screening in the VA from OQP's External Peer Review Program (EPRP) and computerized outpatient clinic and procedure files in Austin. Linking these data, we analyzed receipt of screening and follow-up testing after a positive fecal occult blood test (FOBT).

Results: A total of 39,870 patients met criteria for colorectal cancer screening; of these 61% were screened. Screening was more likly in patients 70-80 years old than in those younger or older. Female gender (RR 0.92 [0.90-0.95]), Blacks (RR 0.92 [0.89-0.96]), lower income and infrequent primary care visits were associated with lower likelihood of screening. Of those patients with a positive FOBT (n=313), 59% received a follow-up barium enema or colonoscopy. Patient-level factors did not predict receipt of a follow-up test.

Conclusions: The VA rates for colorectal cancer screening are significantly higher than the national average. However, 41% of patients with positive FOBTs failed to receive follow-up testing. Efforts to measure the quality of colorectal cancer screening programs should focus on the entire diagnostic process.