National Healthcare Quality and Disparities Report
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- Adverse Events (3)
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- (-) Cancer: Colorectal Cancer (23)
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- Clinical Decision Support (CDS) (1)
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- Low-Income (1)
- Medicaid (1)
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- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (2)
- Patient Experience (1)
- Policy (1)
- Practice Patterns (2)
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- Primary Care (3)
- Quality Improvement (2)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Risk (4)
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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 23 of 23 Research Studies DisplayedShah 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
Radhakrishnan A, Reyes-Gastelum D, Gay B
Primary care provider involvement in thyroid cancer survivorship care.
While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship. The purpose of this study was to understand PCP involvement and confidence in thyroid cancer survivorship care. The investigators found that while PCPs reported being involved in long-term surveillance, gaps remained in their confidence in handling survivorship care. They indicated that thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.
AHRQ-funded; HS024512.
Citation: Radhakrishnan A, Reyes-Gastelum D, Gay B .
Primary care provider involvement in thyroid cancer survivorship care.
J Clin Endocrinol Metab 2020 Sep;105(9):e3300-6. doi: 10.1210/clinem/dgaa437..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Primary Care
Nelson HD, Cantor A, Wagner J
Effectiveness of patient navigation to increase cancer screening in populations adversely affected by health disparities: a meta-analysis.
This study evaluated the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. Two of the investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the USPSTF. Findings indicated that, in populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services.
AHRQ-funded; 290201500009I.
Citation: Nelson HD, Cantor A, Wagner J .
Effectiveness of patient navigation to increase cancer screening in populations adversely affected by health disparities: a meta-analysis.
J Gen Intern Med 2020 Jul 22;35(10):3026-35. doi: 10.1007/s11606-020-06020-9..
Keywords: Cancer, Disparities, Cancer: Colorectal Cancer, Screening, Prevention, Women, Health Promotion
Kanters AE, Vu JV, Schuman AD AE, Vu JV, Schuman AD
Completeness of operative reports for rectal cancer surgery.
This study examined the completeness of operative reports for rectal cancer surgery and whether they contain the key elements recommended by the National Accreditation Program for Rectal Cancer. Ten hospitals in Michigan submitted rectal cancer operative reports from June-December 2018. These reports were analyzed for completeness and to identify key elements in the synoptic operative template. Out of 110 reports, 31 contained all 24 elements and they all used a synoptic template. Overall, 62 reported used a synoptic template and 48 did not.
AHRQ-funded; HS000053.
Citation: Kanters AE, Vu JV, Schuman AD AE, Vu JV, Schuman AD .
Completeness of operative reports for rectal cancer surgery.
Am J Surg 2020 Jul;220(1):165-69. doi: 10.1016/j.amjsurg.2019.09.036..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Quality Improvement, Quality of Care
Mahmoud R, Shah SC, Torres J
Association between indefinite dysplasia and advanced neoplasia in patients with inflammatory bowel diseases undergoing surveillance.
Little is known about the clinical significance of indefinite dysplasia (IND) in patients with inflammatory bowel diseases (IBD) undergoing colonoscopic surveillance for colorectal neoplasia. The investigators conducted a retrospective cohort analysis from 2001 through 2017. They concluded that patients with IBD undergoing colorectal neoplasia surveillance with consistent histopathologic grading of dysplasia, IND was independently associated with a significant increase in risk of advanced colorectal neoplasia.
AHRQ-funded; HS026395.
Citation: Mahmoud R, Shah SC, Torres J .
Association between indefinite dysplasia and advanced neoplasia in patients with inflammatory bowel diseases undergoing surveillance.
Clin Gastroenterol Hepatol 2020 Jun;18(7):1518-27.e3. doi: 10.1016/j.cgh.2019.08.032..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health
De Roo AC, Morris AM, Vu JV
Characteristics of patients seeking second opinions at a multidisciplinary colorectal cancer clinic.
The purpose of this study was to describe the patient and treatment characteristics of patients seeking initial and second opinions in colorectal cancer care at a multidisciplinary colorectal cancer clinic. Findings showed that patients seeking a second opinion represent a unique subset of patients with colorectal cancer. In general, they are younger and more likely to have stage IV or recurrent disease than patients seeking an initial opinion. Although transfer of care to a multidisciplinary colorectal cancer clinic after second opinion is lower than for initial consultations, multidisciplinary colorectal cancer clinics provide an important role for patients with complex disease characteristics and treatment needs.
AHRQ-funded; HS000053.https://www.pubmed.ncbi.nlm.nih.gov/32109918
Citation: De Roo AC, Morris AM, Vu JV .
Characteristics of patients seeking second opinions at a multidisciplinary colorectal cancer clinic.
Dis Colon Rectum 2020 Jun;63(6):788-95. doi: 10.1097/dcr.0000000000001647..
Keywords: Cancer: Colorectal Cancer, Cancer, Transitions of Care
Davis SN, Wischhusen JW, Sutton SK
Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans.
This study examined the frequency of limited health literacy and demographic and psychosocial factors associated with limited health literacy in a sample of older black Americans. The participants enrolled in a community-based intervention to promote colorectal cancer screening and completed baseline surveys that assessed their health literacy using the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test, CRC awareness, cancer fatalism, Preventive Health Model (PHM) constructs, and demographics. Findings showed that limited health literacy was associated with multiple complex factors. Recommendations include interventions to incorporate patient health literacy and low-literacy materials that can be delivered through multiple channels.
AHRQ-funded; HS026120.
Citation: Davis SN, Wischhusen JW, Sutton SK .
Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans.
Patient Educ Couns 2020 Feb;103(2):385-91. doi: 10.1016/j.pec.2019.08.026..
Keywords: Health Literacy, Racial and Ethnic Minorities, Elderly, Screening, Cancer: Colorectal Cancer, Cancer, Prevention
Takvorian SU, Oganisian A, Mamtani R
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. The objective of this study was to examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer.
AHRQ-funded; HS026116.
Citation: Takvorian SU, Oganisian A, Mamtani R .
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
JAMA Netw Open 2020 Feb 5;3(2):e1921653. doi: 10.1001/jamanetworkopen.2019.21653.
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Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Lung Cancer, Cancer, Health Insurance, Medicaid, Policy, Health Services Research (HSR)
Murphy CC, Sen A, Watson B
A systematic review of repeat fecal occult blood tests for colorectal cancer screening.
This systematic review examined the prevalence of repeat fecal occult blood tests (FOBT) for colorectal cancer screening. MEDLINE, Embase, and the Cochrane Library were searched for studies published from 1997 to 2017 and reported repeat FOBT over 2 and more screening rounds. Thirty-five articles (n=27) were identified which measured repeat FOBT as 1) proportion of Round 1 participants completing repeat FOBT in Round 2; 2) proportion completing two, consecutive FOBTs; or 3) proportion completing 3 or more rounds. The number of participants completing Round 1 ranged from 24.6% to 89.6%. Those who completed Round 2 ranged from 16.4% to 80%; and completion of 3 or more rounds ranged from 0.8% to 64.1%. Repeat FOBT was higher in mailed outreach than opportunistic screening.
AHRQ-funded; HS022418.
Citation: Murphy CC, Sen A, Watson B .
A systematic review of repeat fecal occult blood tests for colorectal cancer screening.
Cancer Epidemiol Biomarkers Prev 2020 Feb;29(2):278-87. doi: 10.1158/1055-9965.Epi-19-0775..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Diagnostic Safety and Quality, Prevention, Patient Adherence/Compliance, Patient-Centered Outcomes Research, Evidence-Based Practice
De Roo AC, Li Y, Abrahamse PH
Long-term functional decline after high-risk elective colorectal surgery in older adults.
This study examined the long-term risks of functional decline after elective colorectal surgery in older adults. This retrospective matched cohort study used data from the Health and Retirement Study, a nationally representative, longitudinal survey of adults >50 years of age. This survey collected data on functional status, cognition, and demographics, among other topics. The survey was linked with Medicare claims and National Death Index data from 1992 to 2012 and used patients 65 years and older. Surgery patients did experience a greater likelihood of functional decline with or without complications compared to control subjects. The older the patient, the more likelihood of a functional decline occurring after surgery.
AHRQ-funded; HS000053.
Citation: De Roo AC, Li Y, Abrahamse PH .
Long-term functional decline after high-risk elective colorectal surgery in older adults.
Dis Colon Rectum 2020 Jan;63(1):75-83. doi: 10.1097/dcr.0000000000001541..
Keywords: Elderly, Cancer: Colorectal Cancer, Cancer, Surgery, Adverse Events, Risk
Schlick CJR, Liu JY, Yang AD
Pre-operative, intra-operative, and post-operative factors associated with post-discharge venous thromboembolism following colorectal cancer resection.
Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. The objectives of this study were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator.
AHRQ-funded; HS024516; HS026385.
Citation: Schlick CJR, Liu JY, Yang AD .
Pre-operative, intra-operative, and post-operative factors associated with post-discharge venous thromboembolism following colorectal cancer resection.
J Gastrointest Surg 2020 Jan;24(1):144-54. doi: 10.1007/s11605-019-04354-2..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Blood Clots, Adverse Events, Risk, Hospital Discharge
Kanters AE, Cleary RK, Obi SH
Uptake of total mesorectal excision and total mesorectal excision grading for rectal cancer: a statewide study.
Investigators sought to assess trends in total mesorectal excision performance and grading in Michigan hospitals. They found that the rates of total mesorectal excision performance and grade assignment were widely variable throughout the state of Michigan. Overall, grade assignment remained very low, suggesting an opportunity for quality improvement projects to increase total mesorectal excision performance and grading, involving both the surgeons and pathologists for effective implementation.
AHRQ-funded; HS000053.
Citation: Kanters AE, Cleary RK, Obi SH .
Uptake of total mesorectal excision and total mesorectal excision grading for rectal cancer: a statewide study.
Dis Colon Rectum 2020 Jan;63(1):53-59. doi: 10.1097/dcr.0000000000001526..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Quality Improvement, Quality of Care
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
Lewis CL, Kistler CE, Dalton AF
A decision aid to promote appropriate colorectal cancer screening among older adults: a randomized controlled trial.
The purpose of this study was to test a patient decision aid (PtDA) to promote CRC screening in older adults. The PtDA was designed to facilitate individual decision-making to help patients understand the potential risks and benefit of CRC screening. 424 patients aged 70 – 84 who were not up to date with CRC screening participated in a double-blinded randomized controlled trial, using the PtDA or an attention control. Two outcomes - appropriate CRC screening behavior at 6 months following the initial visit or appropriate screening intent immediately after the visit - were defined as completed screening or intent for patients in good health, discussion about screening with their provider for patients in intermediate health, or no screening or intent for patients in poor health. Appropriate screening behavior at 6 months was higher in the intervention group; appropriate screening intent following the provider visit was also higher. The authors conclude that the PtDA for older adults promoted appropriate CRC screening behavior.
AHRQ-funded; HS021133.
Citation: Lewis CL, Kistler CE, Dalton AF .
A decision aid to promote appropriate colorectal cancer screening among older adults: a randomized controlled trial.
Med Decis Making 2018 Jul;38(5):614-24. doi: 10.1177/0272989x18773713..
Keywords: Cancer, Cancer: Colorectal Cancer, Shared Decision Making, Education: Patient and Caregiver, Elderly, Prevention, Screening
Kanters AE, Morris AM, Albrahamse PH
The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care.
Dis Colon Rectum 2018 Jul;61(7):817-23. doi: 10.1097/dcr.0000000000001067.
The purpose of this study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. The study demonstrated that exposure to peer support is associated with higher adjuvant chemotherapy adherence.
The purpose of this study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. The study demonstrated that exposure to peer support is associated with higher adjuvant chemotherapy adherence.
AHRQ-funded; HS000053.
Citation: Kanters AE, Morris AM, Albrahamse PH .
The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care.
Dis Colon Rectum 2018 Jul;61(7):817-23. doi: 10.1097/dcr.0000000000001067..
Keywords: Cancer: Colorectal Cancer, Treatments, Guidelines, Medication, Patient Adherence/Compliance
Abelson JS, Chait A, Shen MJ
Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study.
The objective of this qualitative study was to explore sources of distress among colorectal cancer patients undergoing surgery. The investigators found that patients identified sources of stress at preoperative, in-hospital recovery and postoperative stages. Sources of stress included, but were not limited to: emotional reaction to diagnosis, negative emotional reaction to having a surgery, dealing with distressing physical symptoms and complications after surgery.
AHRQ-funded; HS000066.
Citation: Abelson JS, Chait A, Shen MJ .
Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study.
J Surg Res 2018 Jun;226:140-49. doi: 10.1016/j.jss.2018.01.017..
Keywords: Adverse Events, Cancer, Cancer: Colorectal Cancer, Stress, Surgery
Kistler CE, Vu M, Sutkowi-Hemstreet A
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
This study sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening. While most providers' reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request.
AHRQ-funded; HS019468; HS021133.
Citation: Kistler CE, Vu M, Sutkowi-Hemstreet A .
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
Int J Gen Med 2018 May 17;11:179-90. doi: 10.2147/ijgm.s153887..
Keywords: Cancer: Colorectal Cancer, Cancer: Prostate Cancer, Primary Care, Practice Patterns, Screening
Singal AG, Corley DA, Kamineni A
Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States.
The objectives of this study were to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac fecal occult blood test (gFOBT) or fecal immunochemical test (FIT). The investigators found that screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities.
AHRQ-funded; HS022418.
Citation: Singal AG, Corley DA, Kamineni A .
Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States.
Am J Gastroenterol 2018 May;113(5):746-54. doi: 10.1038/s41395-018-0023-x..
Keywords: Screening, Cancer: Colorectal Cancer, Cancer, Practice Patterns, Diagnostic Safety and Quality
Roydhouse JK, Gutman R, Keating NL
Differences between proxy and patient assessments of cancer care experiences and quality ratings.
This study assessed the impact of proxy survey responses on cancer care experience reports and quality ratings. Adjusted proxy scores were modestly higher for medical care experiences but lower for nursing care and care coordination experiences. There were no significant differences between adjusted patient and proxy ratings of quality.
AHRQ-funded; HS000011.
Citation: Roydhouse JK, Gutman R, Keating NL .
Differences between proxy and patient assessments of cancer care experiences and quality ratings.
Health Serv Res 2018 Apr;53(2):919-43. doi: 10.1111/1475-6773.12672.
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Keywords: Cancer, Cancer: Colorectal Cancer, Cancer: Lung Cancer, Quality of Care, Patient Experience
Davis MM, Freeman M, Shannon J
A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States - how, what and when?
Researchers conducted this systematic review to determine how implementation strategies and contextual factors influenced the uptake of interventions to increase fecal testing for colorectal cancer in rural and low-income populations. They found that provision of kits through the mail, use of pre-addressed stamped envelopes, client reminders and in-clinic distribution appeared most frequently in the highly effective/effective clinic-based study arms. Few studies described contextual factors or implementation strategies.
AHRQ-funded; HS022981.
Citation: Davis MM, Freeman M, Shannon J .
A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States - how, what and when?
BMC Cancer 2018 Jan 6;18(1):40. doi: 10.1186/s12885-017-3813-4.
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Keywords: Cancer: Colorectal Cancer, Health Promotion, Low-Income, Rural Health, Screening
Naber SK, Kuntz KM, Henrikson NB
AHRQ Author: Ganiats TG
Cost effectiveness of age-specific screening intervals for people with family histories of colorectal cancer.
Despite relative risk of colorectal cancer (CRC) decreasing with age among individuals with a family history of CRC, no screening recommendations specify less frequent screening. Researchers found that for individuals with a family history of CRC, it is cost effective to gradually increase the screening interval if several subsequent screening colonoscopies have negative results and no new cases of CRC are found in family members.
AHRQ-authored.
Citation: Naber SK, Kuntz KM, Henrikson NB .
Cost effectiveness of age-specific screening intervals for people with family histories of colorectal cancer.
Gastroenterology 2018 Jan;154(1):105-16.e20. doi: 10.1053/j.gastro.2017.09.021.
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Keywords: Cancer: Colorectal Cancer, Healthcare Costs, Family Health and History, Risk, Screening
Kistler CE, Golin C, Sundaram A
Individualized colorectal cancer screening discussions between older adults and their primary care providers: a cross-sectional study.
The aim of this study was to describe colorectal cancer (CRC) screening discussions and explore their associations with patient characteristics and screening intentions. The investigators found that CRC screening discussions varied by type of participant and content. They assert that future work is needed to determine if interventions focused on specific domains alters the appropriateness of participants' colorectal cancer screening intentions.
AHRQ-funded; HS021133.
Citation: Kistler CE, Golin C, Sundaram A .
Individualized colorectal cancer screening discussions between older adults and their primary care providers: a cross-sectional study.
MDM Policy Pract 2018 Jan-Jun;3(1):2381468318765172. doi: 10.1177/2381468318765172..
Keywords: Cancer: Colorectal Cancer, Shared Decision Making, Elderly, Primary Care, Screening