Complete diagnostic evaluation in colorectal cancer screening: Research design and baseline findings

Background. While indicated by guidelines, complete diagnostic evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium. e nema X ray), is often not recommended and performed for persons with an abn ormal screening fecal occult blood test (FOBT) result. We initiated a rando mized trial to assess the impact of a physician-oriented intervention on CD E rates in primary care practices. Methods. In 1998, we identified 1,184 primary care physicians (PCPs) in 584 practices whose patients received FOBTs that are mailed annually by a mana ged care organization screening program. A total of 470 PCPs in 318 practic es completed a baseline survey. Practices were randomly assigned either to a Control Group (N = 198) or to an Intervention Group (N = 120). Control Gr oup practices received the screening program. Intervention Group practices received the screening program and the intervention (i.e., CDE reminder-fee dback plus educational outreach). Practice CDE recommendation and performan ce rates are the primary outcomes to be measured in the study. Results. Baseline CDE recommendation and performance rates were low and wer e comparable in Control and Intervention Group practices (54 to 57% and 39 to 40%, respectively). PCPs in the practices tended to view FOBT screening and CDE favorably, but had concerns about screening efficacy, time involved in CDE, and patient discomfort and adherence. Control Group physicians wer e more likely than Intervention Group physicians to believe that a mail-out FOBT screening program helps in the practice of medicine. Conclusions. We were able to enroll a high proportion of targeted primary c are practices, measure practice characteristics and CDE rates at baseline, and develop and implement the intervention. Study outcome analyses will tak e into account baseline differences in practice characteristics. (C) 2001 A merican Health Foundation and Academic Press.