Research and Analytics, American Medical Group Association, Alexandria, Virginia.
Now with Albany Medical College.
JAMA Netw Open. 2024 Mar 4;7(3):e242693. doi: 10.1001/jamanetworkopen.2024.2693.
The current quality performance measure for colorectal cancer (CRC) screening is limited to initial screening. Despite low rates, there is no measure for appropriate follow-up with colonoscopy after receipt of an abnormal result of a stool-based screening test (SBT) for CRC. A quality performance measure is needed.
To develop and test a quality performance measure for follow-up colonoscopy within 6 months of an abnormal result of an SBT for CRC.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective quality improvement study examined data from January 1, 2016, to December 31, 2020, with 2018 plus 6 months of follow-up as the primary measurement period to verify performance rates, specify a potential measure, and test for validity, reliability, and feasibility. The Optum Labs Data Warehouse (OLDW), a deidentified database of health care claims and clinical data, was accessed. The OLDW contains longitudinal health information on enrollees and patients, representing a diverse mixture of ages and geographic regions across the US. For the database study, adults from 38 health care organizations (HCOs) aged 50 to 75 years who completed an initial CRC SBT with an abnormal result were observed to determine follow-up colonoscopy rates within 6 months. Rates were stratified by race, ethnicity, sex, insurance, and test modality. Three HCOs participated in the feasibility field testing. Data were analyzed from June 1, 2022, to May 31, 2023.
The primary outcome consisted of follow-up colonoscopy rates following an abnormal SBT result for CRC. Reliability statistics were also calculated across HCOs, race, ethnicity, and measurement year.
Among 20 581 adults (48.6% men and 51.4% women; 307 [1.5%] Asian, 492 [7.2%] Black, 644 [3.1%] Hispanic, and 17 705 [86.0%] White; mean [SD] age, 63.6 [7.1] years) in 38 health systems, 47.9% had a follow-up colonoscopy following an abnormal SBT result for CRC within 6 months. There was significant variation between HCOs. Notably, significantly fewer Black patients (37.1% [95% CI, 34.6%-39.5%]) and patients with Medicare (49.2% [95% CI, 47.7%-50.6%]) or Medicaid (39.2% [95% CI, 36.3%-42.1%]) insurance received a follow-up colonoscopy. A quality performance measure that tracks rates of follow-up within 6 months of an abnormal SBT result was observed to be feasible, valid, and reliable, with a median reliability statistic between HCOs of 94.5% (range, 74.3%-99.7%).
The findings of this observational study of 20 581 adults suggest that a measure of follow-up colonoscopy within defined periods after an abnormal result of an SBT test for CRC is warranted based on low current performance rates and would be feasible to collect by health systems and produce valid, reliable results.
目前结直肠癌（CRC）筛查的质量绩效衡量标准仅限于初始筛查。尽管初始筛查的比例较低，但对于接受基于粪便的 CRC 筛查试验（SBT）异常结果后的结肠镜检查，尚无适当的后续措施。需要制定一个质量绩效衡量标准。
开发和测试 SBT 异常结果后 6 个月内进行结肠镜检查的后续措施的质量绩效衡量标准。
设计、地点和参与者：本回顾性质量改进研究分析了 2016 年 1 月 1 日至 2020 年 12 月 31 日的数据，将 2018 年加 6 个月的随访作为主要测量期，以验证绩效率，指定潜在的衡量标准，并测试有效性、可靠性和可行性。访问了 Optum Labs Data Warehouse（OLDW），这是一个匿名的医疗保健索赔和临床数据数据库。OLDW 包含参保者和患者的纵向健康信息，代表了美国不同年龄段和地理区域的多样化混合体。对于数据库研究，来自 38 个医疗保健组织（HCO）的 50 至 75 岁完成初始 CRC SBT 且结果异常的成年人被观察以确定 6 个月内的结肠镜检查率。根据种族、族裔、性别、保险和检测方式对这些比率进行分层。有三个 HCO 参加了可行性现场测试。数据分析于 2022 年 6 月 1 日至 2023 年 5 月 31 日进行。
主要结果包括 SBT 异常后 CRC 后续结肠镜检查的比率。还在 HCO、种族、族裔和测量年度之间计算了可靠性统计数据。
在 38 个医疗系统中的 20581 名成年人（48.6%为男性，51.4%为女性；307[1.5%]为亚洲人，492[7.2%]为黑人，644[3.1%]为西班牙裔，17705[86.0%]为白人；平均[标准差]年龄，63.6[7.1]岁）中，47.9%的人在 SBT 异常后 6 个月内接受了结肠镜检查。HCO 之间存在显著差异。值得注意的是，黑人患者（37.1%[95%CI，34.6%-39.5%]）和接受医疗保险（49.2%[95%CI，47.7%-50.6%]）或医疗补助（39.2%[95%CI，36.3%-42.1%]）保险的患者接受结肠镜检查的比例明显较低。一项跟踪 SBT 异常后 6 个月内结肠镜检查率的质量绩效衡量标准被观察到是可行的、有效的和可靠的，HCO 之间的中位数可靠性统计数据为 94.5%（范围，74.3%-99.7%）。
本研究对 20581 名成年人的观察性研究结果表明，根据目前较低的绩效水平，有必要制定一项衡量标准，以衡量 SBT 试验异常结果后规定时间内的结肠镜检查情况，并且这一衡量标准在 HCO 中是可行的，可以收集有效的、可靠的结果。
