Li Andrew Tong, Burns Shohei, Martinez Dalia, Wang Patricia, Aggarwal Sona, Potter Michael, Sarkar Urmimala, Somsouk Ma
School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
medRxiv. 2025 Jun 9:2025.06.07.25327375. doi: 10.1101/2025.06.07.25327375.
Organized screening programs automate fecal immunochemical test (FIT) outreach based on chronological age. However, providers and patients may defer screening due to coexisting conditions, which can be captured by International Classification of Disease, 10 revision (ICD-10) codes. We sought to identify codes associated with not having a FIT order.
We included screen-eligible patients with a primary care visit between June 2022 and June 2023. We enumerated and compared the frequency of each ICD-10 code between patients with and without a FIT ordered. We conducted a subgroup analysis including only those with a Charlson comorbidity index (CCI) <5.
We identified 15,020 screen-eligible patients, with 10,187 (67.8%) patients having had a FIT order and 4,833 (32.3%) patients without a FIT order. Of the 1,215 ICD-10 codes examined, 96 were significantly associated with not having a FIT order. One broad category of codes pertained to digestive diseases such as benign and malignant colonic neoplasms (ICD-10 code C18, odds ratio (OR) 0.06, 95% CI [0.001-0.44]) and diverticular disease (K57, OR 0.26 [0.18-0.36]). Another category was comorbid conditions which included frailty (R54, OR 0.14 [0.03-0.55]) and paralysis (G82, OR 0.14 [0.03-0.55]). Those with acute conditions such as cervical fractures (S12, OR 0.23 [0.10-0.48]) and cryptococcosis (B45, OR 0.05 [0.001-0.38]) were also less likely to have a FIT order. Among the patients with CCI<5, 41 codes were significantly associated with not having a FIT order, including heart failure (I50, OR 0.55 [0.43-0.71]) and chronic kidney disease (N18, OR 0.58 [0.43-0.77]).
Patients deferred from screening were more likely to have ICD-10 codes signifying digestive diseases, comorbidities, and acute conditions. Even among patients with fewer co-morbid conditions, we identified health conditions that were associated with screening deferral. Future work should consider whether screening programs could incorporate ICD-10 codes to align FIT outreach more closely with provider and patient preferences.
有组织的筛查项目会根据年龄自动开展粪便免疫化学检测（FIT）推广工作。然而，由于并存疾病，医疗服务提供者和患者可能会推迟筛查，而这些并存疾病可以通过国际疾病分类第10版（ICD - 10）编码来记录。我们试图找出与未开具FIT检测医嘱相关的编码。
我们纳入了在2022年6月至2023年6月期间进行过初级保健就诊且符合筛查条件的患者。我们列举并比较了开具FIT检测医嘱的患者和未开具FIT检测医嘱的患者中每个ICD - 10编码的出现频率。我们进行了亚组分析，仅纳入Charlson合并症指数（CCI）<5的患者。
我们确定了15,020名符合筛查条件的患者，其中10,187名（67.8%）患者开具了FIT检测医嘱，4,833名（32.3%）患者未开具FIT检测医嘱。在所检查的1,215个ICD - 10编码中，有96个与未开具FIT检测医嘱显著相关。一类主要编码涉及消化系统疾病，如良性和恶性结肠肿瘤（ICD - 10编码C18，比值比（OR）0.06，95%置信区间[0.001 - 0.44]）和憩室病（K57，OR 0.26 [0.18 - 0.36]）。另一类是合并症，包括身体虚弱（R54，OR 0.14 [0.03 - 0.55]）和瘫痪（G82，OR 0.14 [0.03 - 0.55]）。患有急性疾病如颈椎骨折（S12，OR 0.23 [0.10 - 0.48]）和隐球菌病（B45，OR 0.05 [0.001 - 0.38]）的患者也不太可能开具FIT检测医嘱。在CCI<5的患者中，有41个编码与未开具FIT检测医嘱显著相关，包括心力衰竭（I50，OR 0.55 [0.43 - 0.71]）和慢性肾病（N18，OR 0.58 [0.43 - 0.77]）。
推迟筛查的患者更有可能有表示消化系统疾病、合并症和急性疾病的ICD - 10编码。即使在合并症较少的患者中，我们也确定了与筛查推迟相关的健康状况。未来的工作应考虑筛查项目是否可以纳入ICD - 10编码，以使FIT推广工作更紧密地符合医疗服务提供者和患者的偏好。
