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. 2012 Dec;27(12):1618-25.
doi: 10.1007/s11606-012-2163-9. Epub 2012 Jul 19.

Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration

Melissa R Partin  1 , Adam A Powell, Ann Bangerter, Krysten Halek, James F Burgess Jr, Deborah A Fisher, David B Nelson
Affiliations

Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration

Melissa R Partin et al. J Gen Intern Med. 2012 Dec.

Abstract

Background: Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented.

Objective: To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample.

Design: Observational

Participants: 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.

Main measures: We 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. We 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. We 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.

Key results: 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.

Conclusions: Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.

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Figures

Figure 1.
Figure 1.
Subject flow diagram.
Figure 2.
Figure 2.
Percent of FOBT overused, by reason and year.
Figure 3.
Figure 3.
Number of FOBT and colonoscopy procedures by year.
See this image and copyright information in PMC

Comment in

  • Fecal occult blood test (FOBT) overuse.
    Federman DG. Federman DG. J Gen Intern Med. 2013 May;28(5):610. doi: 10.1007/s11606-013-2396-2. J Gen Intern Med. 2013. PMID: 23456698 Free PMC article. No abstract available.
  • Fecal occult blood test (FOBT) overuse.
    Partin MR, Powell AA, Burgess JF Jr. Partin MR, et al. J Gen Intern Med. 2013 May;28(5):611. doi: 10.1007/s11606-013-2397-1. J Gen Intern Med. 2013. PMID: 23475642 Free PMC article. No abstract available.

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