Levels and variation in overuse of fecal occult blood testing in the veterans health administration
Journal of General Internal Medicine, 08/10/2012
Partin MR et al. – Many fecal occult blood tests (FOBTs) are performed sooner than recommended in the Veterans Health Administration (VHA). Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system–level solutions.Methods
- A observational study.
- Participants included 1,844 CRCS–eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009.
- Authors combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation.
- They coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema.
- They used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities.
- Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures.
- FOBT overuse varied across facilities (9–32 %, p<0.0001) and region (12–23 %, p<.0012).
- FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %–5 %, p=.0492), but overuse after other procedures increased (11–19 %, p=.0002).
- FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p<0.001), but did not vary by patient demographics.
- More than 11 % of overused FOBTs were followed by colonoscopy within 12 months.