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Measuring complete diagnostic evaluation in colorectal cancer screening
R E Myers1, G Fishbein, T Hyslop
1Thomas Jefferson University, Department of Medicine, Philadelphia, PA 19107, USA.
Cancer Detection and Prevention
|May 9, 2001
Summary
Accurate measurement of complete diagnostic evaluation (CDE) use is crucial for colorectal cancer (CRC) screening. The combined internal chart audit and administrative data review method offers a highly sensitive and specific approach for tracking CDE performance.
Area of Science:
- Health Services Research
- Gastroenterology
- Public Health
Background:
- Complete diagnostic evaluation (CDE) is recommended following abnormal screening fecal occult blood tests for colorectal cancer (CRC).
- Accurate measurement of CDE utilization is essential for effective CRC screening programs.
Purpose of the Study:
- To compare the sensitivity and specificity of various methods for measuring CDE recommendation and performance.
- To identify the most accurate method for assessing CDE use in CRC screening.
Main Methods:
- The study evaluated five methods: external chart audit (ECA) only, internal chart audit (ICA) only, administrative data review (ADR) of electronic claims, ICA plus ADR, and ECA plus ADR (gold standard).
- Sensitivity and specificity of each method were assessed against the gold standard for both CDE recommendation and performance.
Main Results:
- For CDE recommendation, the ICA plus ADR method showed high sensitivity (0.901) and specificity (≥0.95).
- For CDE performance, ICA plus ADR demonstrated the highest sensitivity (0.965) with perfect specificity (1.0).
- External chart audit (ECA) only also showed high sensitivity for both recommendation (0.926) and performance (0.877).
Conclusions:
- The combination of internal chart audit and administrative data review (ICA-plus-ADR) is a highly sensitive and specific measure for assessing complete diagnostic evaluation use.
- This combined method should be considered for monitoring primary care physician follow-up of abnormal CRC screening results.
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