Article Figures & Data
Figures
- Figure 1.
Study flow diagram
ADR=administrative data review; CDE=complete diagnostic evaluation; ICA=internal chart audit.
Tables
- Table 1.
Characteristics of Practices With Patients Who Had Positive Fecal Occult Blood Test Results but No Complete Diagnostic Evaluation (N = 201)
Characteristic n (%) Note: Not all practices provided complete demographic information. Missing numbers are from solo practices. General practice made up just 8%, or 4% of the practices, and was combined with family medicine. Administrative arrangement Solo 53 (26) Group 148 (74) Physician age (median) Less than 45 years 90 (45) 45 years or older 109 (55) Specialty Family medicine 146 (73) Internal medicine 44 (22) Both specialties 11 (5) Board certified 100% 154 (77) Not 100% 47 (23) Sex All male 133 (66) Not all male 68 (34) Ethnicity All white 163 (81) Not all white 38 (19) Years in practice (median) <18 y 91 (45) ≥18 y 109 (55) - Table 2.
Reasons for Primary Care Physicians’ Nonperformance of Complete Diagnostic Evaluation and Compatibility With Guidelines
Reasons by Categories No. of Patients % Note: More than 1 reason could be cited for each patient. a All documented reasons were compatible with guidelines for 102 patients (83%): 1 reason for 98 patients and 2 reasons for 4 patients. At least 1 reason was compatible with guidelines for 21 patients (17%): 1 of 2 reasons for 14 patients and 1 of 3 reasons for 7 patients. b No documented reason was compatible with guidelines: 1 reason for 76 patients, 2 reasons for 17 patients, and 3 reasons for 1 patient. c One reason reported for 151 patients, and 2 reasons reported for 20 patients. d Reasons from both nonphysician factors and physician decision compatible with guidelines were reported for 17 patients. Reasons from both nonphysician factors and physician decision not compatible with guidelines were reported for 19 patients. Reasons from nonphysician factors and physician decisions both compatible and not compatible with the guidelines were reported for 5 patients. Physician decision 217 33 Compatible with the guidelinesa 123 19 Not compatible with the guidelinesb 94 14 Nonphysician factors 212 32 Nonphysician factors onlyc 171 26 Combined physician decision and nonphysician factorsd 41 6 No documented reasons 232 35 Total 661 100
Supplemental Appendix
Supplemental Appendix. Sample Internal Chart Audit Form
Files in this Data Supplement:
- Supplmental data: Appendix - PDF file, 1 page, 124 KB
The Article in Brief
Reasons Patients With a Positive Fecal Occult Blood Test Result Do Not Undergo Complete Diagnostic Evaluation
Masahito Jimbo , and colleagues
Background The fecal occult blood test (FOBT) is an effective method of screening patients for colorectal cancer. To be effective at preventing colon cancer, positive FOBT tests must be followed up with further testing, such as colonoscopy. However, in practice, follow-up of positive FOBT results does not always occur. This study examines reasons for this low rate of complete diagnostic evaluation following a positive FOBT.
What This Study Found For a majority of patients, primary care doctors' reported reasons for not performing a complete diagnostic evaluation are appropriate. A common reason for not performing a complete diagnostic evaluation is that one had been completed within 3 years before the FOBT-positive result. Further analysis, however, shows that a significant proportion of decisions not to perform a complete evaluation are not compatible with established guidelines.
Implications
- Because decision making by primary care doctors appears to have a major effect on whether a complete diagnostic evaluation is performed after a positive FOBT result, colorectal screening programs should include guidance for doctors on this issue.
- These findings will shed light on potential strategies to help doctors improve rates of complete diagnostic evaluation in FOBT-positive patients.
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