在加利福尼亚南部 8 家联邦合格健康中心，基于粪便免疫化学检测异常的诊断性结肠镜检查完成情况和检测质量：改善筛查结果的机会。
Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes.
机构信息
University of California San Diego, La Jolla, California.
Moores Cancer Center, University of California San Diego, La Jolla, California.
出版信息
Cancer. 2019 Dec 1;125(23):4203-4209. doi: 10.1002/cncr.32440. Epub 2019 Sep 3.
BACKGROUND
The effectiveness of colorectal cancer screening with fecal immunochemical tests (FITs) of stool blood depends on high rates of colonoscopy follow-up for abnormal FITs and the use of high-quality tests. This study characterized colonoscopy referral and completion among patients with abnormal FITs and the types of FITs implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs).
METHODS
FQHCs in San Diego, Imperial, and Los Angeles Counties were invited to define a cohort of ≥150 consecutive patients with abnormal FITs in 2015-2016 and to provide data on sex, insurance status, diagnostic colonoscopy referrals and completion within 6 months of abnormal FITs, and the types (brands) of FITs implemented. The primary outcomes were the proportions with colonoscopy referrals and completion for all patients at each FQHC and in aggregate.
RESULTS
Eight FQHCs provided data for 1229 patients with abnormal FITs; 46% were male, and 20% were uninsured. Among patients with abnormal FITs, 89% (1091 of 1229; 95% confidence interval [CI], 0.87-0.91) had a colonoscopy referral, and 44% (539 of 1229; 95% CI, 0.41-0.47) had colonoscopy completion. Across FQHCs, the range for colonoscopy referral was 73% to 96%, and the range for completion was 18% to 57%. Six of the 8 FQHCs (75%) reported FIT brands with limited data to support their effectiveness.
CONCLUSIONS
In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FITs was substantially below the nationally recommended benchmark to achieve 80% completion, and the use of FIT brands with limited data to support their effectiveness was high. These findings suggest a need for policies and multilevel interventions to promote diagnostic colonoscopy among individuals with abnormal FITs and the use of higher quality FITs.
背景
粪便免疫化学检测（FIT）筛查结直肠癌的效果取决于高比例的结肠镜检查对异常 FIT 的随访以及高质量检测的使用。本研究对南加州联邦合格医疗中心（FQHC）中异常 FIT 患者的结肠镜转诊和完成情况以及实施的 FIT 类型进行了特征描述。
方法
圣地亚哥、帝国和洛杉矶县的 FQHC 被邀请在 2015-2016 年确定一个连续 150 名以上异常 FIT 患者的队列，并提供有关性别、保险状况、诊断性结肠镜检查转诊和异常 FIT 后 6 个月内完成情况以及实施的 FIT 类型（品牌）的数据。主要结局是每个 FQHC 和总体上所有患者的结肠镜转诊和完成比例。
结果
8 家 FQHC 为 1229 名异常 FIT 患者提供了数据；46%为男性，20%为无保险者。在异常 FIT 患者中，89%（1091 例/1229 例；95%置信区间[CI]，0.87-0.91）接受了结肠镜检查转诊，44%（539 例/1229 例；95%CI，0.41-0.47）完成了结肠镜检查。在 FQHC 之间，结肠镜检查转诊率的范围为 73%至 96%，完成率的范围为 18%至 57%。8 家 FQHC 中有 6 家（75%）报告了 FIT 品牌，其有效性数据有限。
结论
在南加州 FQHC 的一个样本中，异常 FIT 后诊断性结肠镜检查的完成率远低于全国推荐的 80%完成率标准，且使用有效性数据有限的 FIT 品牌的比例很高。这些发现表明，需要制定政策和多层次干预措施，以促进异常 FIT 患者的诊断性结肠镜检查，并使用更高质量的 FIT。
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