Kaiser Permanente Division of Research, Oakland, California, USA.
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Clin Transl Gastroenterol. 2019 Feb;10(2):e00010. doi: 10.14309/ctg.0000000000000010.
The effectiveness of fecal immunochemical test (FIT) screening for colorectal cancer depends on timely colonoscopy follow-up of positive tests, although limited data exist regarding effective system-level strategies for improving follow-up rates.
Using a mixed-methods design (qualitative and quantitative), we first identified system-level strategies that were implemented for improving timely follow-up after a positive FIT test in a large community-based setting between 2006 and 2016. We then evaluated changes in time to colonoscopy among FIT-positive patients across 3 periods during the study interval, controlling for screening participant age, sex, race/ethnicity, comorbidity, FIT date, and previous screening history.
Implemented strategies over the study period included setting a goal of colonoscopy follow-up within 30 days of a positive FIT, tracking FIT-positive patients, early telephone contact to directly schedule follow-up colonoscopies, assigning the responsibility for follow-up tracking and scheduling to gastroenterology departments (vs primary care), and increasing colonoscopy capacity. Among 160,051 patients who had a positive FIT between 2006 and 2016, 126,420 (79%) had a follow-up colonoscopy within 180 days, including 67% in 2006-2008, 79% in 2009-2012, and 83% in 2013-2016 (P < 0.001). Follow-up within 180 days in 2016 varied moderately across service areas, between 72% (95% CI 70-75) and 88% (95% CI 86-91), but there were no obvious differences in the pattern of strategies implemented in higher- vs lower-performing service areas.
The implementation of system-level strategies coincided with substantial improvements in timely colonoscopy follow-up after a positive FIT. Intervention studies are needed to identify the most effective strategies for promoting timely follow-up.
粪便免疫化学检测（FIT）筛查结直肠癌的有效性取决于对阳性检测结果及时进行结肠镜检查随访，尽管目前关于提高随访率的有效系统层面策略的相关数据有限。
采用混合方法设计（定性和定量），我们首先确定了在 2006 年至 2016 年期间，在一个大型基于社区的环境中，为改善阳性 FIT 检测后及时进行结肠镜检查而实施的系统层面策略。然后，我们在研究期间的 3 个时期，通过控制筛查参与者的年龄、性别、种族/民族、合并症、FIT 日期和既往筛查史，评估了 FIT 阳性患者进行结肠镜检查的时间变化。
在研究期间实施的策略包括设定在阳性 FIT 后 30 天内进行结肠镜检查的目标，对 FIT 阳性患者进行跟踪，早期通过电话直接预约随访结肠镜检查，将随访跟踪和预约的责任分配给胃肠病科（而非初级保健科），并增加结肠镜检查能力。在 2006 年至 2016 年期间，共有 160051 例患者的 FIT 结果呈阳性，其中 126420 例（79%）在 180 天内进行了结肠镜检查，包括 2006-2008 年为 67%，2009-2012 年为 79%，2013-2016 年为 83%（P<0.001）。2016 年，各服务区域的 180 天内随访率差异适中，在 72%（95%CI 70-75）至 88%（95%CI 86-91）之间，但在高绩效和低绩效服务区域实施的策略模式没有明显差异。
实施系统层面策略与阳性 FIT 后及时进行结肠镜检查随访的大幅改善相一致。需要进行干预研究以确定促进及时随访的最有效策略。
