Search

Background Targeted interventions to promote colorectal cancer screening among specific populations could increase screening rates. Patients with an expired order for screening colonoscopy might be persuaded to follow through with screening by such an intervention. Methods We conducted a randomized controlled trial of a combined reminder/outreach intervention among patients in a large general internal medicine practice. Participants included 628 patients aged 50 to 79 years with an expired order for screening colonoscopy. Patients were stratified based on receipt of any previous colorectal cancer screening and randomly assigned either to (1) an intervention group that received a mailing containing a reminder letter from their primary care physician, a brochure and digital video disc about colorectal cancer and colorectal cancer screening, and a follow-up telephone call or (2) a usual care control group. The primary outcome was receipt of fecal occult blood testing, sigmoidoscopy, or colonoscopy within 3 months of randomization. Screening outcomes were observed for an additional 3 months (6 months from randomization). Results Screening rates at 3 months were 9.9% (31 of 314 patients) in the intervention group and 3.2% (10 of 314 patients) in the control group (rate ratio, 3.1; 95% confidence interval, 1.5-6.2; P = .001). At 6 months, rates were 18.2% (57 of 314 patients) and 12.1% (38 of 314 patients), respectively (rate ratio, 1.5; 95% confidence interval, 1.03-2.2; P = .03). Conclusion Patient outreach to individuals with an expired order for colonoscopy may be an effective tool to modestly increase short-term completion of colorectal cancer screening. Trial registration clinicaltrials.gov Identifier: NCT00793455.

Background Despite high cardiovascular risk among adults with diabetes mellitus, aspirin use has been low. Methods To assess recent self-reported regular aspirin use among adults 35 years or older with diabetes, we used statewide telephone surveys conducted in 7 states in 1997 and 20 states in 1999 and 2001 including 875, 3205, and 4272 subjects in 1997, 1999, and 2001, respectively. Results Aspirin use increased from 37.5% in 1997 to 48.7% in 2001. In 2001, 74.2% (95% confidence interval [CI], 70.9%-77.5%) of diabetic adults with cardiovascular disease, but only 37.9% (95% CI, 35.1%-40.7%) of those without cardiovascular disease, used aspirin regularly, including less than 40% with diagnosed hypertension or hypercholesterolemia or who smoked. After adjusting for cardiac risk factors and socioeconomic characteristics, among those without cardiovascular disease, aspirin use was less common in women aged 35 to 49 years (adjusted rate ratio [RR], 0.35; 95% CI, 0.24-0.51) and 50 to 64 years (RR, 0.69; 95% CI, 0.53-0.88) and in men aged 35 to 49 years (RR, 0.62; 95% CI, 0.43-0.85) compared with men 65 years and older. For those with diagnosed cardiovascular disease, aspirin use was lower among women (RR, 0.81 compared with men; 95% CI, 0.70-0.90) and adults younger than 50 years (RR compared with those ≥65 years, 0.81; 95% CI, 0.61-0.98). The disparity in aspirin use between men and women appeared between 1997 and 2001. Conclusions Aspirin use among adults with diabetes has increased. However, many high-risk individuals, especially women and those younger than 50 years, do not use this effective and inexpensive therapy.

Background Nationally endorsed, clinical performance measures are available that allow for quality reporting using electronic health records (EHRs). To our knowledge, how well they reflect actual quality of care has not been studied. We sought to evaluate the validity of performance measures for coronary artery disease (CAD) using an ambulatory EHR. Methods We performed a retrospective electronic medical chart review comparing automated measurement with a 2-step process of automated measurement supplemented by review of free-text notes for apparent quality failures for all patients with CAD from a large internal medicine practice using a commercial EHR. The 7 performance measures included the following: antiplatelet drug, lipid-lowering drug, β-blocker following myocardial infarction, blood pressure measurement, lipid measurement, low-density lipoprotein cholesterol control, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for patients with diabetes mellitus or left ventricular systolic dysfunction. Results Performance varied from 81.6% for lipid measurement to 97.6% for blood pressure measurement based on automated measurement. A review of free-text notes for cases failing an automated measure revealed that misclassification was common and that 15% to 81% of apparent quality failures either satisfied the performance measure or met valid exclusion criteria. After including free-text data, the adherence rate ranged from 87.5% for lipid measurement and low-density lipoprotein cholesterol control to 99.2% for blood pressure measurement. Conclusions Profiling the quality of outpatient CAD care using data from an EHR has significant limitations. Changes in how data are routinely recorded in an EHR are needed to improve the accuracy of this type of quality measurement. Validity testing in different settings is required.