A centrally generated primary care physician audit report does not improve colonoscopy uptake after a positive result on a fecal occult blood test in Ontario's ColonCancerCheck program

作者：Stock D^*; Rabeneck L; Baxter N N; Paszat L F; Sutradhar R; Yun L; Tinmouth J

来源：Current Oncology, 2017, 24(1): 47-51.

DOI：10.3747/co.24.3025

• Fecal occult blood test
• colonoscopy
• colorectal cancer
• screening
• program evaluation

Background Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (FOBT) result within Ontario's population-wide ColonCancerCheck Program.
Methods This prospective cohort study used data sets from Ontario's ColonCancerCheck Program (2008-2011) that were linked to provincial administrative health databases. Cox proportional hazards regression was used to estimate the effect of centralized, physician-targeted audit and feedback on colonoscopy uptake in an Ontario-wide fobt-positive cohort. Results A mailed physician audit and feedback report identifying individuals outstanding for colonoscopy for 3 or more months after a positive FOBT result did not increase the likelihood of colonoscopy uptake ( hazard ratio: 0.95; 95% confidence interval: 0.79 to 1.13). Duration of positive FOBT status was strongly inversely associated with the hazard of follow-up colonoscopy (p for linear trend: <0.001).
Conclusions In a large population-wide setting, centralized tracking in the form of physician-targeted mailed audit and feedback reports does not improve colonoscopy uptake for screening participants with a positive FOBT result outstanding for 3 or more months. Mailed physician-targeted screening audit and feedback reports alone are unlikely to improve compliance with follow-up colonoscopy in Ontario. Other interventions such as physician audits or automatic referrals, demonstrated to be effective in other jurisdictions, might be warranted.

• 出版日期2017-2
• 单位河北医科大学