Evaluation of a VHA collaborative to improve follow-up after a positive colorectal cancer screening test

Med Care. 2011 Oct;49(10):897-903. doi: 10.1097/MLR.0b013e3182204944.


Background: In 2005, the Veterans Health Administration initiated a yearlong Colorectal Cancer Care Collaborative (C4) to improve timely follow-up after positive fecal occult blood tests.

Methods: Twenty-one facilities formed local quality improvement (QI) teams. Teams received QI training, created process flow maps, implemented process changes, and shared learning through 2 face-to-face meetings, conference calls, and a discussion board. We evaluated pre-post change in the timeliness of follow-up among C4 facilities and 3 control facilities. Outcome measures included the proportion of patients receiving a follow-up colonoscopy within 1 year, the proportion receiving 60-day follow-up (the focus of C4 teams), and average days to colonoscopy. Survey data from C4 team members was analyzed to identify predictors of facility-level improvement.

Results: Both C4 and control facilities improved on 1-year follow-up (10% and 9% increases, respectively, both P's<0.001). There was a statistically significant increase in the proportion receiving 60-day follow-up among C4 facilities (27% pre-C4 vs. 39% post-C4, P=0.008) but a nonsignificant decrease among control facilities (45% pre-C4 vs. 29% post-C4, P=0.14). Average days to colonoscopy decreased significantly among C4 facilities (129 pre-C4 vs. 103 post-C4, P=0.004) but increased significantly among control facilities (81 pre-C4 vs. 103 post-C4, P=0.04). Teams with the most improvement established clear roles/goals, had previous QI training, made more use of QI tools, and incorporated primary care education into their improvement work.

Conclusions: A Veterans Health Administration improvement collaborative modestly decreased time to colonoscopy after a positive colorectal cancer screening test but significant room for improvement remains and benefits of participation were not realized by all facilities.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Colonoscopy
  • Colorectal Neoplasms / prevention & control*
  • Continuity of Patient Care / standards*
  • Cooperative Behavior
  • Female
  • Hospitals, Veterans
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Occult Blood
  • Quality Assurance, Health Care*
  • United States
  • United States Department of Veterans Affairs