National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 38 Research Studies DisplayedLiu PH, Singal AG, Murphy CC
Colorectal cancer screening receipt does not differ by 10-year mortality risk among older adults.
This study examined receipt of past-year colorectal cancer (CRC screening) according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up-to-date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index with the lowest to highest quintiles of the index ranging from 12%-79%. The authors also examined the proportion of screening performed among adults with life expectancy <10 years. They found that the prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk, demonstrating that the odds of CRC screening did not differ in the lowest vs highest quintile. One-quarter of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults aged 75-84 years had 10-year mortality risk ≥50% at the time of screening. Invasive but not noninvasive screening increased as 10-year mortality risk increased among adults aged 70-79 years.
AHRQ-funded; HS022418.
Citation: Liu PH, Singal AG, Murphy CC .
Colorectal cancer screening receipt does not differ by 10-year mortality risk among older adults.
Am J Gastroenterol 2024 Feb; 119(2):353-63. doi: 10.14309/ajg.0000000000002536.
Keywords: Elderly, Cancer: Colorectal Cancer, Mortality, Screening, Colonoscopy
Ferrari RM, Atkins DL, Wangen M
Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.
The objective of this study was to assess patient perspectives on receiving fecal immunochemical colorectal cancer (CRC) screening tests through pharmacies. Researchers conducted semi-structured interviews with participants in North Carolina and Washington. Survey participants reported pharmacy-based CRC screening programs to be highly acceptable, citing convenience, ease of access, and avoidance of co-pays, but they also had concerns about privacy and coordination with primary care providers. The researchers concluded that CRC screening in pharmacies is potentially a good option, provided patients have privacy and their primary care providers are informed.
AHRQ-funded; HS026122.
Citation: Ferrari RM, Atkins DL, Wangen M .
Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.
Transl Behav Med 2023 Dec 15; 13(12):909-18. doi: 10.1093/tbm/ibad057..
Keywords: Provider: Pharmacist, Cancer: Colorectal Cancer, Colonoscopy, Screening, Prevention
Hicklin K, O'Leary MC, Nambiar S
Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: what would it take to reach national screening targets in North Carolina?
The authors simulated the impact of multicomponent interventions in North Carolina over 5 years to assess the potential for meeting national screening targets for colorectal cancer (CRC). They reported that each multicomponent intervention was associated with increased CRC screening and averted both CRC cases and deaths, while three had the potential to reach screening targets.
AHRQ-funded; HS022981.
Citation: Hicklin K, O'Leary MC, Nambiar S .
Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: what would it take to reach national screening targets in North Carolina?
Prev Med 2022 Sep;162:107126. doi: 10.1016/j.ypmed.2022.107126..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Colonoscopy, Prevention
Schwartz HEM, Abel MK, Lin JA, et al. HEM, Abel MK, Lin JA
Barriers to colorectal cancer screening and surveillance in homeless patients: a case report and policy recommendations.
Researchers described the barriers encountered by a homeless patient with a history of colorectal cancer who was lost to follow up and presented 11 years later with a new primary colon cancer. They provided policy solutions to increase the use of primary and secondary screening, including essential private bathroom access for colonoscopy preparation in patients who had a positive screening or who require surveillance after diagnosis and treatment. They concluded that increasing early detection and treatment may be cost-effective and could reduce disparities in morbidity and mortality in homeless patients.
AHRQ-funded; HS024532.
Citation: Schwartz HEM, Abel MK, Lin JA, et al. HEM, Abel MK, Lin JA .
Barriers to colorectal cancer screening and surveillance in homeless patients: a case report and policy recommendations.
Ann Surg Open 2022 Sep;3(3):e183. doi: 10.1097/as9.0000000000000183..
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Vulnerable Populations, Screening, Access to Care, Case Study
Fendrick AM, Dalton VK, Tilea A
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
The objective of this study was to describe out-of-pocket costs for colposcopy and related services among age-appropriate, commercially insured women from 2006 to 2019. Findings suggested that out-of-pocket costs for colposcopy were very common and significant and have increased over time. Reported out-of-pocket costs for cervical cancer screening-related care, such as office visits, were not included, thus the findings may underestimate patients’ total financial burden.
AHRQ-funded; HS025465.
Citation: Fendrick AM, Dalton VK, Tilea A .
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
Obstet Gynecol 2022 Jan;139(1):113-15. doi: 10.1097/aog.0000000000004582..
Keywords: Healthcare Costs, Colonoscopy, Screening, Cancer: Cervical Cancer, Cancer, Prevention, Women
Reddy P, Mencin A, Lebwohl B
Risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients.
Suboptimal bowel cleansing is common in children and can impact diagnostic and therapeutic outcomes. In this retrospective study, the investigators aimed to identify risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients. The investigators concluded that Medicaid status and English as a second language were risk factors. They highlighted distinct associations from those reported in the adult literature including failure to thrive and younger age.
AHRQ-funded; HS026121.
Citation: Reddy P, Mencin A, Lebwohl B .
Risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients.
J Pediatr Gastroenterol Nutr 2021 Jul;73(1):e1-e6. doi: 10.1097/mpg.0000000000003114..
Keywords: Children/Adolescents, Colonoscopy, Risk, Diagnostic Safety and Quality
Sanchez JI, Shankaran V, Unger JM
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underused, especially among racial/ethnic minorities. This study assessed the association between patient and neighborhood factors and receipt of surveillance colonoscopy. The investigators concluded that receipt of initial surveillance colonoscopy remained low, and that there were acute disparities between Black and NHW patients.
AHRQ-funded; HS013853.
Citation: Sanchez JI, Shankaran V, Unger JM .
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
Cancer 2021 Feb;127(3):412-21. doi: 10.1002/cncr.33262..
Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Access to Care, Screening, Prevention, Disparities, Medicare
Vu JV, Sheetz KH, De Roo AC
Variation in colectomy rates for benign polyp and colorectal cancer.
Removal of pre-cancerous polyps on screening colonoscopy is a mainstay of colorectal cancer (CRC) prevention. Complex polyps may require surgical removal with colectomy, an operation with a 17% morbidity and 1.5% mortality rate. Recently, advanced endoscopic techniques have allowed some patients with complex polyps to avoid the morbidity of colectomy. In this study, the investigators compared regional variation in colectomy rates for CRC versus benign polyp.
AHRQ-funded; HS000053.
Citation: Vu JV, Sheetz KH, De Roo AC .
Variation in colectomy rates for benign polyp and colorectal cancer.
Surg Endosc 2021 Feb;35(2):802-08. doi: 10.1007/s00464-020-07451-5..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Colonoscopy
Shah SC, Itzkowitz SH
Reappraising risk factors for inflammatory bowel disease-associated neoplasia: implications for colonoscopic surveillance in IBD.
One of the most feared complications of inflammatory bowel disease [IBD]-associated colitis is colorectal cancer. An opportunity for early detection is being missed in a group that is overlooked as high-risk, as a substantial proportion of colorectal cancers are being diagnosed in individuals with colonic IBD who have disease duration shorter than when guidelines recommend surveillance initiation. In this study, the investigators discuss a viewpoint that supports a paradigm shift that will ideally result in a more effective and higher-value colorectal cancer prevention approach in IBD.
AHRQ-funded; HS026395.
Citation: Shah SC, Itzkowitz SH .
Reappraising risk factors for inflammatory bowel disease-associated neoplasia: implications for colonoscopic surveillance in IBD.
J Crohns Colitis 2020 Sep 7;14(8):1172-77. doi: 10.1093/ecco-jcc/jjaa040..
Keywords: Digestive Disease and Health, Risk, Cancer: Colorectal Cancer, Cancer, Colonoscopy, Prevention, Diagnostic Safety and Quality, Screening
Abraham NS
Antiplatelets, anticoagulants, and colonoscopic polypectomy.
This article is a review of current best practice recommendations focusing on the risk of immediate and delayed postpolypectomy bleeding in the context of drug discontinuation or continuation of antiplatelet and anticoagulant drugs. Data was assessed whether cold snare vs conventional thermal-based polypectomy technology and prophylactic placement of hemostatic clips are endoscopic techniques that are beneficial in reducing polypectomy bleeding. Clinical takeaways are also provided to facilitate safer polypectomy among patients on antiplatelet and anticoagulant agents.
AHRQ-funded; HS025402.
Citation: Abraham NS .
Antiplatelets, anticoagulants, and colonoscopic polypectomy.
Gastrointest Endosc 2020 Feb;91(2):257-65. doi: 10.1016/j.gie.2019.09.033..
Keywords: Blood Thinners, Medication, Medication: Safety, Colonoscopy, Adverse Drug Events (ADE), Adverse Events, Guidelines, Prevention, Patient Safety
Davis MM, Gunn R, Pham R
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
This study focused on ways that Medicaid Accountable Care Organizations (ACOs) are implementing interventions with primary care clinics to improve colorectal cancer screening. The researchers conducted a comparative case study of 14 Medicaid ACOs in Oregon and their contracted primary care clinics. They focused on interventions that reduced structural barriers (12 ACOs), delivered provider assessment and feedback (11 ACOs), and provided patient reminders (7 ACOs). There was an unintended consequence of potential exclusion of smaller clinics and metric focus and fatigue.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Pham R .
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
Prev Chronic Dis 2019 Aug 15;16:E107. doi: 10.5888/pcd16.180395..
Keywords: Primary Care: Models of Care, Primary Care, Screening, Colonoscopy, Cancer: Colorectal Cancer, Cancer, Quality Improvement, Quality of Care, Care Coordination, Patient-Centered Healthcare
Song LD, Newhouse JP, Garcia-De-Albeniz X
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
This study examined changes in screening colonoscopy rates after Medicare reimbursement and cost-sharing changed when the Affordable Care Act (ACA) was implemented. A 20% random sample of fee-for-service (FFS) Medicare claims from 2002-2012 was used in this study. Screening colonoscopy rates did increase after 2001 when cost-sharing was eliminated but the amount varied depending on the algorithm used to classify the indication.
AHRQ-funded; HS023128.
Citation: Song LD, Newhouse JP, Garcia-De-Albeniz X .
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
Health Serv Res 2019 Aug;54(4):839-50. doi: 10.1111/1475-6773.13150..
Keywords: Colonoscopy, Healthcare Costs, Healthcare Utilization, Medicare, Payment, Prevention, Screening
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Shared Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Mobley LR, Kuo TM, Zhou M
What happened to disparities in CRC screening among FFS Medicare enrollees following Medicare modernization?
This study examined the effects of the change in policy for colorectal screening that was implemented in 2006 for FFS Medicare beneficiaries. This new policy eliminated copayments for colonoscopies or sigmoidoscopies. Disparities in screening by race (Blacks, Asians and Hispanics relative to Whites), and gender (Males relative to Females). The time periods 2001-2005 and 2006-2009 were compared and while there was some improvement in screening rates for minorities and women, the progress was unevenly distributed across the USA.
AHRQ-funded; HS021752.
Citation: Mobley LR, Kuo TM, Zhou M .
What happened to disparities in CRC screening among FFS Medicare enrollees following Medicare modernization?
J Racial Ethn Health Disparities 2019 Apr;6(2):273-91. doi: 10.1007/s40615-018-0522-x..
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Disparities, Medicare, Screening
Magrath M, Yang E, Ahn C
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Results showed that an EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
AHRQ-funded; HS022418.
Citation: Magrath M, Yang E, Ahn C .
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
J Natl Compr Canc Netw 2018 Nov;16(11):1321-28. doi: 10.6004/jnccn.2018.7050..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Colonoscopy, Cancer: Colorectal Cancer, Screening, Cancer, Guidelines, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention
Predmore Z, Pannikottu J, Sharma R
Factors associated with the overuse of colorectal cancer screening: a systematic review.
The purpose of this systematic review was to examine factors associated with overuse of colorectal cancer (CRC) screening, using studies that were in English, used a U.S. population, and contained original data. The review indicates that overuse of CRC screening was greater in the Northeast/Mid-Atlantic regions and in urban areas, but was lower in academically affiliated centers. The authors conclude that, although the literature supports important overuse of CRC screening, what drives these practices remains unclear and that future research should explore these factors thoroughly.
AHRQ-funded; HS000029.
Citation: Predmore Z, Pannikottu J, Sharma R .
Factors associated with the overuse of colorectal cancer screening: a systematic review.
Am J Med Qual 2018 Sep/Oct;33(5):472-80. doi: 10.1177/1062860618764302..
Keywords: Cancer, Cancer: Colorectal Cancer, Colonoscopy, Prevention, Screening
Wang P, Xu T, Ngamruengphong S
Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA.
This study aimed to estimate the rates of infections after colonoscopy and osophagogastroduodenoscopies (OGD) performed in ambulatory surgery centres (ASCs). The study found that postendoscopic infections are more common than previously thought and vary widely by facility. Although screening colonoscopy is not without risk, the risk is lower than diagnostic endoscopic procedures.
AHRQ-funded; HS024806.
Citation: Wang P, Xu T, Ngamruengphong S .
Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA.
Gut 2018 May 18;67(9):1626-36. doi: 10.1136/gutjnl-2017-315308..
Keywords: Adverse Events, Colonoscopy, Healthcare-Associated Infections (HAIs), Risk, Ambulatory Care and Surgery
Crawford J, Beaton D, Almad F
AHRQ Author: Bierman AS
Cross-cultural survey development: the colon cancer screening behaviors survey for South Asian populations.
The objective of this work was to develop a survey that considered cultural relevance and diversity of South Asian populations, with the aim of describing or predicting factors that influence colorectal cancer screening intention and adherence. The initial development of the Colon Cancer Screening Behaviours Survey for South Asian populations was completed using a number of steps. This initial survey was later cross-culturally translated and adapted into the Urdu language.
AHRQ-authored.
Citation: Crawford J, Beaton D, Almad F .
Cross-cultural survey development: the colon cancer screening behaviors survey for South Asian populations.
BMC Res Notes 2017 Dec 28;10(1):770. doi: 10.1186/s13104-017-3098-3.
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Keywords: Cancer, Cancer: Colorectal Cancer, Colonoscopy, Patient Adherence/Compliance, Racial and Ethnic Minorities, Screening
Singal AG, Gupta S, Skinner CS
Effect of colonoscopy outreach vs fecal immunochemical test outreach on colorectal cancer screening completion: a randomized clinical trial.
Researchers compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase completion of the colorectal cancer (CRC) screening process (screening initiation and follow-up) within 3 years. Among persons aged 50 to 64 years receiving primary care at a safety-net institution, mailed outreach invitations offering FIT or colonoscopy compared with usual care increased the proportion completing CRC screening process within 3 years.
AHRQ-funded; HS022418.
Citation: Singal AG, Gupta S, Skinner CS .
Effect of colonoscopy outreach vs fecal immunochemical test outreach on colorectal cancer screening completion: a randomized clinical trial.
JAMA 2017 Sep 5;318(9):806-15. doi: 10.1001/jama.2017.11389.
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Comparative Effectiveness, Patient-Centered Outcomes Research
Davis MM, Renfro S, Pham R
Geographic and population-level disparities in colorectal cancer testing: a multilevel analysis of Medicaid and commercial claims data.
This study used Medicaid and commercial claims data to examine individual and geographic factors associated with colorectal cancer testing rates in Oregon. CRC testing in newly age-eligible Medicaid and commercial members remains markedly low. Disparities exist by gender, geographic residence, insurance coverage, and access to primary care.
AHRQ-funded; HS022981.
Citation: Davis MM, Renfro S, Pham R .
Geographic and population-level disparities in colorectal cancer testing: a multilevel analysis of Medicaid and commercial claims data.
Prev Med 2017 Aug;101:44-52. doi: 10.1016/j.ypmed.2017.05.001.
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Disparities, Medicaid, Social Determinants of Health
Garcia-Albeniz X, Hsu J, Hernan MA
The value of explicitly emulating a target trial when using real world evidence: an application to colorectal cancer screening.
Researchers reviewed a recent observational analysis that explicitly emulated a target trial of screening colonoscopy using insurance claims from U.S. Medicare. They then compared this explicit emulation with alternative, simpler observational analyses. This empirical comparison suggests that lack of an explicit emulation of the target trial leads to biased estimates, and shows that allowing for repeated eligibility increases the statistical efficiency of the estimates.
AHRQ-funded; HS023128.
Citation: Garcia-Albeniz X, Hsu J, Hernan MA .
The value of explicitly emulating a target trial when using real world evidence: an application to colorectal cancer screening.
Eur J Epidemiol 2017 Jun;32(6):495-500. doi: 10.1007/s10654-017-0287-2.
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Comparative Effectiveness, Evidence-Based Practice, Research Methodologies
Ngo-Metzger Q, Rajupet S
AHRQ Author: Ngo-Metzger Q
Screening for colorectal cancer.
This case study involves a 50-year-old woman who presents for a routine visit. She is healthy with no significant medical history, takes no medications, and has no personal or family history of cancer. She asks about colorectal cancer screening. There are three multiple choice questions together with the U.S. Preventive Services Task Force answers, recommendations and related background information.
AHRQ-authored.
Citation: Ngo-Metzger Q, Rajupet S .
Screening for colorectal cancer.
Am Fam Physician 2017 May 15;95(10):653-54.
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Keywords: Cancer: Colorectal Cancer, Case Study, Colonoscopy, Prevention, Screening
Issaka RB, Singh MH, Oshima SM
Inadequate utilization of diagnostic colonoscopy following abnormal FIT results in an integrated safety-net system.
The effectiveness of stool-based colorectal cancer (CRC) screening is contingent on colonoscopy completion in patients with an abnormal fecal immunochemical test (FIT). This study found that FIT positive patients never referred to gastroenterology or who missed their appointment after referrals were more likely to have comorbid conditions and documented illicit substance use compared with patients who completed a colonoscopy.
AHRQ-funded; HS023558.
Citation: Issaka RB, Singh MH, Oshima SM .
Inadequate utilization of diagnostic colonoscopy following abnormal FIT results in an integrated safety-net system.
Am J Gastroenterol 2017 Feb;112(2):375-82. doi: 10.1038/ajg.2016.555.
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Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Diagnostic Safety and Quality
Garcia-Albeniz X, Hsu J, Bretthauer M
Effectiveness of screening colonoscopy to prevent colorectal cancer among Medicare beneficiaries aged 70 to 79 years: a prospective observational study.
The researchers evaluated the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years. They concluded that screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries.
AHRQ-funded; HS023128.
Citation: Garcia-Albeniz X, Hsu J, Bretthauer M .
Effectiveness of screening colonoscopy to prevent colorectal cancer among Medicare beneficiaries aged 70 to 79 years: a prospective observational study.
Ann Intern Med 2017 Jan 3;166(1):18-26. doi: 10.7326/m16-0758.
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Elderly, Prevention, Screening
Martin J, Halm EA, Tiro JA
Reasons for lack of diagnostic colonoscopy after positive result on fecal immunochemical test in a safety-net health system.
This study aimed to characterize factors contributing to lack of follow-up colonoscopy in a racially diverse and socioeconomically disadvantaged cohort of patients with abnormal results on the fecal immunochemical test receiving care in an integrated safety-net health system. It concluded that lack of diagnostic evaluation is related to a combination of patient-, provider-, and system-level factors, highlighting the need for multilevel interventions to improve follow-up colonoscopy completion rates.
AHRQ-funded; HS022418.
Citation: Martin J, Halm EA, Tiro JA .
Reasons for lack of diagnostic colonoscopy after positive result on fecal immunochemical test in a safety-net health system.
Am J Med 2017 Jan;130(1):93.e1-93.e7. doi: 10.1016/j.amjmed.2016.07.028.
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Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Diagnostic Safety and Quality