Primary care visit use after positive fecal immunochemical test for colorectal cancer screening

Grace Clarke Hillyer, Christopher D. Jensen, Wei K. Zhao, Alfred I. Neugut, Benjamin Lebwohl, Jasmin A. Tiro, Lawrence H. Kushi, Douglas A. Corley

Research output: Contribution to journalArticle

Abstract

BACKGROUND: For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. METHODS: Among 483,216 individuals aged 50 to 75 years who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, the authors evaluated whether a positive test was associated with a net change in outpatient primary care visit use within the year after screening. Multivariable regression models were used to evaluate the relationship between test result group and net changes in primary care visits after fecal immunochemical testing. RESULTS: In the year after the fecal immunochemical test, use increased by 0.60 clinic visits for patients with true-positive results. The absolute change in visits was largest (3.00) among individuals with positive test results who were diagnosed with colorectal cancer, but significant small increases also were found for patients treated with polypectomy and who had no neoplasia (0.36) and those with a normal examination and no polypectomy performed (0.17). Groups of patients who demonstrated an increase in net visit use compared with the true-negative group included patients with true-positive results (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.54-1.66), and positive groups with a colorectal cancer diagnosis (OR, 7.19; 95% CI, 6.12-8.44), polypectomy/no neoplasia (OR, 1.37; 95% CI, 1.27-1.48), and normal examination/no polypectomy (OR, 1.24; 95% CI, 1.18-1.30). CONCLUSIONS: Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have a substantial impact on total health care use. Therefore, these changes should be included in colorectal cancer screening cost models and their causes investigated further.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2017

Fingerprint

Early Detection of Cancer
Colorectal Neoplasms
Primary Health Care
Odds Ratio
Confidence Intervals
Ambulatory Care
Delivery of Health Care
Compliance
Health Services
Neoplasms
Costs and Cost Analysis

Keywords

  • Colorectal cancer
  • Delivery of health care
  • Early detection of cancer
  • Primary health care

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Hillyer, G. C., Jensen, C. D., Zhao, W. K., Neugut, A. I., Lebwohl, B., Tiro, J. A., ... Corley, D. A. (Accepted/In press). Primary care visit use after positive fecal immunochemical test for colorectal cancer screening. Cancer. https://doi.org/10.1002/cncr.30809

Primary care visit use after positive fecal immunochemical test for colorectal cancer screening. / Hillyer, Grace Clarke; Jensen, Christopher D.; Zhao, Wei K.; Neugut, Alfred I.; Lebwohl, Benjamin; Tiro, Jasmin A.; Kushi, Lawrence H.; Corley, Douglas A.

In: Cancer, 2017.

Research output: Contribution to journalArticle

Hillyer, GC, Jensen, CD, Zhao, WK, Neugut, AI, Lebwohl, B, Tiro, JA, Kushi, LH & Corley, DA 2017, 'Primary care visit use after positive fecal immunochemical test for colorectal cancer screening', Cancer. https://doi.org/10.1002/cncr.30809
Hillyer, Grace Clarke ; Jensen, Christopher D. ; Zhao, Wei K. ; Neugut, Alfred I. ; Lebwohl, Benjamin ; Tiro, Jasmin A. ; Kushi, Lawrence H. ; Corley, Douglas A. / Primary care visit use after positive fecal immunochemical test for colorectal cancer screening. In: Cancer. 2017.
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abstract = "BACKGROUND: For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. METHODS: Among 483,216 individuals aged 50 to 75 years who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, the authors evaluated whether a positive test was associated with a net change in outpatient primary care visit use within the year after screening. Multivariable regression models were used to evaluate the relationship between test result group and net changes in primary care visits after fecal immunochemical testing. RESULTS: In the year after the fecal immunochemical test, use increased by 0.60 clinic visits for patients with true-positive results. The absolute change in visits was largest (3.00) among individuals with positive test results who were diagnosed with colorectal cancer, but significant small increases also were found for patients treated with polypectomy and who had no neoplasia (0.36) and those with a normal examination and no polypectomy performed (0.17). Groups of patients who demonstrated an increase in net visit use compared with the true-negative group included patients with true-positive results (odds ratio [OR], 1.60; 95{\%} confidence interval [95{\%} CI], 1.54-1.66), and positive groups with a colorectal cancer diagnosis (OR, 7.19; 95{\%} CI, 6.12-8.44), polypectomy/no neoplasia (OR, 1.37; 95{\%} CI, 1.27-1.48), and normal examination/no polypectomy (OR, 1.24; 95{\%} CI, 1.18-1.30). CONCLUSIONS: Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have a substantial impact on total health care use. Therefore, these changes should be included in colorectal cancer screening cost models and their causes investigated further.",
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AU - Hillyer, Grace Clarke

AU - Jensen, Christopher D.

AU - Zhao, Wei K.

AU - Neugut, Alfred I.

AU - Lebwohl, Benjamin

AU - Tiro, Jasmin A.

AU - Kushi, Lawrence H.

AU - Corley, Douglas A.

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N2 - BACKGROUND: For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. METHODS: Among 483,216 individuals aged 50 to 75 years who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, the authors evaluated whether a positive test was associated with a net change in outpatient primary care visit use within the year after screening. Multivariable regression models were used to evaluate the relationship between test result group and net changes in primary care visits after fecal immunochemical testing. RESULTS: In the year after the fecal immunochemical test, use increased by 0.60 clinic visits for patients with true-positive results. The absolute change in visits was largest (3.00) among individuals with positive test results who were diagnosed with colorectal cancer, but significant small increases also were found for patients treated with polypectomy and who had no neoplasia (0.36) and those with a normal examination and no polypectomy performed (0.17). Groups of patients who demonstrated an increase in net visit use compared with the true-negative group included patients with true-positive results (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.54-1.66), and positive groups with a colorectal cancer diagnosis (OR, 7.19; 95% CI, 6.12-8.44), polypectomy/no neoplasia (OR, 1.37; 95% CI, 1.27-1.48), and normal examination/no polypectomy (OR, 1.24; 95% CI, 1.18-1.30). CONCLUSIONS: Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have a substantial impact on total health care use. Therefore, these changes should be included in colorectal cancer screening cost models and their causes investigated further.

AB - BACKGROUND: For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. METHODS: Among 483,216 individuals aged 50 to 75 years who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, the authors evaluated whether a positive test was associated with a net change in outpatient primary care visit use within the year after screening. Multivariable regression models were used to evaluate the relationship between test result group and net changes in primary care visits after fecal immunochemical testing. RESULTS: In the year after the fecal immunochemical test, use increased by 0.60 clinic visits for patients with true-positive results. The absolute change in visits was largest (3.00) among individuals with positive test results who were diagnosed with colorectal cancer, but significant small increases also were found for patients treated with polypectomy and who had no neoplasia (0.36) and those with a normal examination and no polypectomy performed (0.17). Groups of patients who demonstrated an increase in net visit use compared with the true-negative group included patients with true-positive results (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.54-1.66), and positive groups with a colorectal cancer diagnosis (OR, 7.19; 95% CI, 6.12-8.44), polypectomy/no neoplasia (OR, 1.37; 95% CI, 1.27-1.48), and normal examination/no polypectomy (OR, 1.24; 95% CI, 1.18-1.30). CONCLUSIONS: Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have a substantial impact on total health care use. Therefore, these changes should be included in colorectal cancer screening cost models and their causes investigated further.

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KW - Delivery of health care

KW - Early detection of cancer

KW - Primary health care

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