Partin Melissa R, Gravely Amy A, Burgess James F, Haggstrom David A, Lillie Sarah E, Nelson David B, Nugent Sean M, Shaukat Aasma, Sultan Shahnaz, Walter Louise C, Burgess Diana J
Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Cancer. 2017 Sep 15;123(18):3502-3512. doi: 10.1002/cncr.30765. Epub 2017 May 11.
Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening.
In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression.
Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening).
In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA.
确定了患者、医生和环境因素，作者研究了这些因素对粪便潜血试验/粪便免疫化学试验（FOBT/FIT）筛查呈阳性后结肠镜检查随访中人口统计学和健康差异的影响。
2009年8月16日至2011年3月20日期间，从120个退伍军人健康管理局（VHA）设施中总共识别出76243名FOBT/FIT呈阳性的患者，并对其进行了6个月的随访。从VHA行政记录中确定患者的人口统计学特征（种族/民族、性别、年龄、婚姻状况）和健康特征（合并症）、医生特征（培训水平、是否为初级保健提供者）和行为（不适当的FOBT/FIT筛查）以及环境因素（地理可及性、设施类型）。通过对临床记录进行统计文本挖掘来估计患者行为（拒绝、使用私营部门的结肠镜检查），并使用分层逻辑回归估计随访预测因素和校正率。
约50%的个体在6个月内在VHA设施完成了结肠镜检查。年龄和合并症评分与随访呈负相关。黑人比白人更有可能接受随访。环境因素减弱了但并未完全解释这些差异。患者行为（拒绝、使用私营部门的结肠镜检查）和医生行为（不适当的筛查）完全解释了微小的反向种族差异，并减弱了年龄和合并症评分的差异。患者行为（拒绝和使用私营部门的结肠镜检查）对随访率差异的贡献大于医生行为（不适当的筛查）。
在VHA中，FOBT/FIT结果呈阳性的黑人比白人更有可能接受结肠镜检查随访，并且随访率随着年龄增长和合并症负担的加重而显著下降。患者和医生行为解释了随访率的种族差异，并导致了年龄和合并症负担的差异。《癌症》2017年；123：3502 - 12。2017年发表。本文为美国政府作品，在美国属于公共领域。
