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 46 Research Studies DisplayedMagrath 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, 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, Decision Making, Elderly, Primary Care, Screening
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
Kistler CE, Golin C, Morris C
Design of a randomized clinical trial of a colorectal cancer screening decision aid to promote appropriate screening in community-dwelling older adults.
This paper reports on the design of a randomized clinical trial to understand the effects of a patient decision aid on appropriate colorectal cancer screening. The study aims to determine the ability of a patient decision aid to increase individualized and appropriate colorectal cancer screening.
AHRQ-funded; HS021133.
Citation: Kistler CE, Golin C, Morris C .
Design of a randomized clinical trial of a colorectal cancer screening decision aid to promote appropriate screening in community-dwelling older adults.
Clin Trials 2017 Dec;14(6):648-58. doi: 10.1177/1740774517725289..
Keywords: Cancer, Cancer: Colorectal Cancer, Decision Making, Elderly, Prevention, Screening
Adams LB, Richmond J, Corbie-Smith G
Medical mistrust and colorectal cancer screening among African Americans.
The goal of this systematic review was to summarize evidence investigating associations between medical mistrust and CRC screening among African Americans, and variations in these associations by gender, CRC screening type, and level of mistrust. The study found that quantitative differences in mistrust and CRC screening by gender were mixed, but qualitative studies highlighted fear of experimentation and intrusiveness of screening methods as unique themes among African American men.
AHRQ-funded; HS000032.
Citation: Adams LB, Richmond J, Corbie-Smith G .
Medical mistrust and colorectal cancer screening among African Americans.
J Community Health 2017 Oct;42(5):1044-61. doi: 10.1007/s10900-017-0339-2..
Keywords: Cancer: Colorectal Cancer, Prevention, 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
Pham R, Cross S, Fernandez B
"Finding the right FIT": rural patient preferences for fecal immunochemical test (FIT) characteristics.
This community-led study was conducted to assess patient preferences for fecal immunochemical tests (FIT) characteristics and to use study findings in concert with clinical effectiveness data to inform regional FIT selection. The authors concluded that FIT characteristics influenced patient's perceptions of test acceptability and feasibility and indicated that health system leaders, payers, and clinicians should select FITs that are both clinically effective and incorporate patient preferred test characteristics.
AHRQ-funded; HS022981.
Citation: Pham R, Cross S, Fernandez B .
"Finding the right FIT": rural patient preferences for fecal immunochemical test (FIT) characteristics.
J Am Board Fam Med 2017 Sep-Oct;30(5):632-44. doi: 10.3122/jabfm.2017.05.170151..
Keywords: Cancer: Colorectal Cancer, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Rural Health, Screening
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
Mehta HB, Vargas GM, Adhikari D
Comparative effectiveness of chemotherapy vs resection of the primary tumour as the initial treatment in older patients with Stage IV colorectal cancer.
The objectives were to determine trends in the use of chemotherapy as the initial treatment and to evaluate the comparative effectiveness of initial chemotherapy vs resection of the primary tumor on survival (intention-to-treat analysis) in Stage IV colorectal cancer (CRC). Instrumental variable analysis found that, compared with resection, chemotherapy as the initial treatment offers similar or better 2-year survival in patients with Stage IV CRC.
AHRQ-funded; HS022134.
Citation: Mehta HB, Vargas GM, Adhikari D .
Comparative effectiveness of chemotherapy vs resection of the primary tumour as the initial treatment in older patients with Stage IV colorectal cancer.
Colorectal Dis 2017 Jun;19(6):O210-o18. doi: 10.1111/codi.13659.
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Keywords: Cancer: Colorectal Cancer, Treatments, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
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
Hoffman AS, Lowenstein LM, Kamath GR
An entertainment-education colorectal cancer screening decision aid for African American patients: a randomized controlled trial.
The purpose of this study was to assess whether an entertainment-education decision aid tailored for African American patients improved patients' decision making, attitudes, intentions, or colorectal cancer screening behavior. It found that viewing the culturally tailored decision aid significantly increased African American patients' knowledge of colorectal cancer screening recommendations and options. It also significantly reduced their decisional conflict and improved their self-advocacy.
AHRQ-funded; HS022134.
Citation: Hoffman AS, Lowenstein LM, Kamath GR .
An entertainment-education colorectal cancer screening decision aid for African American patients: a randomized controlled trial.
Cancer 2017 Apr 15;123(8):1401-08. doi: 10.1002/cncr.30489.
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Keywords: Cancer: Colorectal Cancer, Decision Making, Education: Patient and Caregiver, Racial and Ethnic Minorities, Screening
Kanters A, Mullard AJ, Arambula J
Colorectal cancer: quality of surgical care in Michigan.
Surgery remains the cornerstone therapy for colorectal cancer (CRC). This study assesses CRC quality measures for surgical cases in Michigan with data from 30 hospitals in the Michigan Surgical Quality Collaborative (2014-2015). Adjusted process measures showed gaps in quality of care for CRC, suggesting opportunity for regional quality improvement.
AHRQ-funded; HS000053.
Citation: Kanters A, Mullard AJ, Arambula J .
Colorectal cancer: quality of surgical care in Michigan.
Am J Surg 2017 Mar;213(3):548-52. doi: 10.1016/j.amjsurg.2016.11.038.
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Keywords: Cancer: Colorectal Cancer, Quality of Care, Outcomes, Quality Measures, Surgery
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