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Related Experiment Video

Updated: Jun 29, 2025

Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
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Development of a Follow-Up Measure to Ensure Complete Screening for Colorectal Cancer.

Elizabeth L Ciemins1, Jeff T Mohl1, Carlos A Moreno1,2

  • 1Research and Analytics, American Medical Group Association, Alexandria, Virginia.

JAMA Network Open
|March 25, 2024
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A new quality measure for colorectal cancer (CRC) screening follow-up colonoscopy after abnormal stool-based tests (SBTs) is needed. The study found this measure is feasible, valid, and reliable, despite low current follow-up rates.

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Area of Science:

  • Health Services Research
  • Cancer Screening Quality Improvement
  • Health Outcomes

Background:

  • Current colorectal cancer (CRC) screening quality measures focus only on initial screening.
  • There is a lack of standardized measures for appropriate follow-up colonoscopy after abnormal stool-based test (SBT) results.
  • Developing such a measure is crucial for improving CRC detection rates.

Purpose of the Study:

  • To develop and validate a quality performance measure for follow-up colonoscopy within six months of an abnormal CRC SBT result.
  • To assess the feasibility, validity, and reliability of this proposed quality measure.
  • To identify disparities in follow-up colonoscopy rates among different patient populations.

Main Methods:

  • Retrospective analysis of deidentified health claims and clinical data from the Optum Labs Data Warehouse (OLDW) from 2016-2020.
  • Inclusion of adults aged 50-75 from 38 health care organizations (HCOs) who had an abnormal CRC SBT.
  • Calculation of follow-up colonoscopy rates within six months, stratified by demographics and insurance, with feasibility testing in three HCOs.

Main Results:

  • Only 47.9% of 20,581 adults completed follow-up colonoscopy within six months of an abnormal CRC SBT.
  • Significantly lower follow-up rates were observed in Black patients (37.1%) and those with Medicare or Medicaid.
  • The proposed quality measure demonstrated feasibility, validity, and reliability, with a median reliability statistic of 94.5% between HCOs.

Conclusions:

  • A quality performance measure for follow-up colonoscopy after abnormal CRC SBTs is warranted due to low adherence rates.
  • The proposed measure is feasible for health systems to implement and yields valid, reliable data.
  • Addressing disparities in follow-up care is essential for equitable CRC screening outcomes.