Gowda Niraj, Suarez Tatiana Rugeles, Leigh Chike, Bierle Lindsey, Harring Michael, Maldonado-Puebla Martin, Lee Sean M, Shah Neeral, Catalanotti Jillian S
Department of Medicine The George Washington University School of Medicine & Health Sciences Washington DC USA.
Department of Medicine University of Virginia Charlottesville Virginia USA.
JGH Open. 2025 Mar 7;9(3):e70129. doi: 10.1002/jgh3.70129. eCollection 2025 Mar.
Screening for colorectal cancer decreases mortality. Fecal occult blood testing (FOBT) decreases some barriers to screening, however positive results require colonoscopy. We evaluated factors associated with colonoscopy completion for community health center (CHC) patients after positive FOBT.
We identified patients of one CHC with positive FOBT from 1/1/2018-12/31/2021. We performed chart reviews for demographics, insurance status, FOBT date, colonoscopy referral date and site, and colonoscopy results.We performed descriptive analysis. We fitted a logistic model and employed stepwise selection to evaluate effect of variables influencing likelihood of colonoscopy. We employed forward and backward model selection to identify the reduced model with the lowest Akaike Information Criterion score. Using this model, we calculated hypothesis tests for each coefficient using Wald tests with an alpha level of 0.05.
Overall, 50% of participants completed colonoscopy. Mean time between positive FOBT and colonoscopy completion was 237.4 days (SD 187.9). The reduced logistic model included age and health insurance covariates. Insured patients were 221.7% more likely to complete colonoscopy than uninsured patients. A seven-year increase in age was associated with 41.2% increase in likelihood of colonoscopy. An increase of 38 miles to the colonoscopy site was associated with 17.7% decrease in likelihood of completion.
Only half of participants with positive FOBT completed colonoscopy. On average, nearly eight months elapsed between FOBT and colonoscopy. Having insurance was the strongest predictor of colonoscopy, despite available financial aid programs. Longer distances to colonoscopy sites decreased likelihood of completion.
结直肠癌筛查可降低死亡率。粪便潜血试验（FOBT）减少了一些筛查障碍，然而阳性结果需要进行结肠镜检查。我们评估了社区卫生中心（CHC）患者粪便潜血试验呈阳性后与结肠镜检查完成情况相关的因素。
我们确定了2018年1月1日至2021年12月31日期间某社区卫生中心粪便潜血试验呈阳性的患者。我们对人口统计学、保险状况、粪便潜血试验日期、结肠镜检查转诊日期和地点以及结肠镜检查结果进行了病历审查。我们进行了描述性分析。我们拟合了一个逻辑模型，并采用逐步选择法来评估影响结肠镜检查可能性的变量的作用。我们采用向前和向后模型选择法来确定具有最低赤池信息准则分数的简化模型。使用该模型，我们使用α水平为0.05的Wald检验对每个系数进行假设检验。
总体而言，50%的参与者完成了结肠镜检查。粪便潜血试验呈阳性至结肠镜检查完成的平均时间为237.4天（标准差187.9）。简化的逻辑模型包括年龄和医疗保险协变量。参保患者完成结肠镜检查的可能性比未参保患者高221.7%。年龄每增加七岁，结肠镜检查的可能性增加41.2%。到结肠镜检查地点的距离增加38英里，完成检查的可能性降低17.7%。
粪便潜血试验呈阳性的参与者中只有一半完成了结肠镜检查。平均而言，粪便潜血试验和结肠镜检查之间间隔了近八个月。尽管有可用的经济援助计划，但拥有保险是结肠镜检查的最强预测因素。到结肠镜检查地点的距离越长，完成检查的可能性越低。
