University of California, College of Medicine, San Francisco.
University of California, Fielding School of Public Health, Los Angeles.
Am J Clin Oncol. 2019 Sep;42(9):687-691. doi: 10.1097/COC.0000000000000578.
Colonoscopies are effective in finding early stage colorectal cancer (CRC), which when found in a timely manner, dramatically improve survival rates. A significant number of at-risk patients are still not screened. We investigated the utility of a blood-based protein assay to assess for CRC in patients with elevated risk on the quality of preventive care delivered by board-certified primary care physicians (PCPs) in the United States.
We report on the results of a 3-part, longitudinal, randomized controlled trial. Part 1 assessed physicians' ability to identify simulated patients at risk for CRC and found PCPs missed colonoscopy referrals for high-risk patients ~40% of the time. Part 2 randomized PCPs into control and intervention arms and demonstrated that a novel blood-based protein assay increased referral rates for a diagnostic colonoscopy when caring for simulated patients. Part 3, reported herein, compares real-world colonoscopy rates of actual patients cared for by control versus intervention physicians. Part 3 was executed to confirm whether the use of the assay demonstrated the same utility in their real world, high-risk patients as found in part 2 using simulated patients.
In the simulations, physicians with access to the assay were significantly more likely to order diagnostic colonoscopies. Similarly, in real-world practice, patients were also more likely to be referred for a diagnostic colonoscopy (odds ratio, 4.57; 95% confidence interval, 1.19-17.57).
An increase in CRC risk, as indicated by the assay in simulated and real-life patients, was associated with a higher likelihood of appropriate patients being referred to diagnostic colonoscopy.
结肠镜检查可有效发现早期结直肠癌（CRC），及时发现可显著提高生存率。仍有相当数量的高危患者未接受筛查。我们研究了一种基于血液的蛋白检测在评估美国经委员会认证的初级保健医生（PCP）提供的预防性护理质量高的风险患者 CRC 中的效用。
我们报告了一项 3 部分、纵向、随机对照试验的结果。第 1 部分评估了医生识别模拟 CRC 高危患者的能力，发现 PCP 大约 40%的时间错过了高危患者的结肠镜检查转诊。第 2 部分将 PCP 随机分配到对照组和干预组，结果表明，新型血液蛋白检测在模拟患者护理中增加了诊断性结肠镜检查的转诊率。本文报告的第 3 部分比较了对照组和干预组医生实际护理的实际患者的结肠镜检查率。第 3 部分旨在确认在真实世界中，高危患者中使用该检测是否与第 2 部分中使用模拟患者时一样具有相同的效用。
在模拟中，可获得检测的医生更有可能进行诊断性结肠镜检查。同样，在实际实践中，患者也更有可能被转介进行诊断性结肠镜检查（比值比，4.57；95%置信区间，1.19-17.57）。
正如检测在模拟和现实生活中的患者中所表明的那样，CRC 风险的增加与更有可能将适当的患者转介进行诊断性结肠镜检查相关。
