DESCRIPTION: Complete diagnostic evaluation (CDE) for persons with positive
results on fecal occult blood testing (FOBT plus) is a key component of
colorectal cancer screening. Experts consider CDE as either colonoscopy or
double air-contrast barium enema x-ray (BE) with flexible sigmoidoscopy.
These procedures require primary care physician (PCP) referral(s) to
gastroenterologists and colorectal surgeons and/or to radiologists.
However, PCP referral for CDE is infrequent. The investigators' survey
results and pilot study data indicate that PCP practice factors and PCP
misperceptions about indications for CDE are likely to impact CDE referral.
They propose to study PCP referral of FOBT plus patients to CDE in an
established HMO-based colorectal cancer screening program that involves
annual FOBT mailings to 120,000 older adults (50 years of age) in
Pennsylvania and New Jersey.
The study has five phases: (1) conduct a PCP focus group to elucidate
CDE-related issues and barriers and convene an expert panel to develop study
interventions and validate patient CDE referral status; (2) administer a
baseline and endpoint telephone survey to PCPs in HMO-affiliated practices;
(3) conduct a randomized, controlled trial of interventions designed to
improve CDE referral and completion (Control (N is equal to 120),
Intervention Group 1 (N is equal to 120), Intervention Group 2 (N is equal
to 120); (4) collect CDE data from PCP surveys and forms, medical chart
audit, and administrative sources; and (5) analyze intervention impact and
cost-effectiveness. Control Group practices will receive usual care (i.e.,
the USHC Colorectal Cancer Screening Program). Intervention Group 1
practices will receive usual care plus mailed CDE reminder-feedback.
Intervention Group two practices will receive usual care, mailed CDE
reminder-feedback, and two CDE academic detailing outreach visits.
Error Notice
The database may currently be offline for maintenance and should be operational soon. If not, we have been notified of this error and will be reviewing it shortly.
We apologize for the inconvenience.
- The DCCPS Team.
