• Terry L Wahls and Ika Peleg.
• VA Iowa City Health Care System, Iowa City, Iowa, USA. Terry.Wahls@va.gov
• Bmc Fam Pract. 2009 Jan 1;10:65.

BackgroundA cohort of colorectal cancer (CRC) patients represents an opportunity to study missed opportunities for earlier diagnosis.Primary ObjectiveTo study the epidemiology of diagnostic delays and failures to offer/complete CRC screening.Secondary ObjectiveTo identify system- and patient-related factors that may contribute to diagnostic delays or failures to offer/complete CRC screening.MethodsSettingRural Veterans Administration (VA) Healthcare system.ParticipantsCRC cases diagnosed within the VA between 1/1/2000 and 3/1/2007.Data Sourcesprogress notes, orders, and pathology, laboratory, and imaging results obtained between 1/1/1995 and 12/31/2007. Completed CRC screening was defined as a fecal occult blood test or flexible sigmoidoscopy (both within five years), or colonoscopy (within 10 years); delayed diagnosis was defined as a gap of more than six months between an abnormal test result and evidence of clinician response. A summary abstract of the antecedent clinical care for each patient was created by a certified gastroenterologist (GI), who jointly reviewed and coded the abstracts with a general internist (TW).ResultsThe study population consisted of 150 CRC cases that met the inclusion criteria. The mean age was 69.04 (range 35-91); 99 (66%) were diagnosed due to symptoms; 61 cases (46%) had delays associated with system factors; of them, 57 (38% of the total) had delayed responses to abnormal findings. Fifteen of the cases (10%) had prompt symptom evaluations but received no CRC screening; no patient factors were identified as potentially contributing to the failure to screen/offer to screen. In total, 97 (65%) of the cases had missed opportunities for early diagnosis and 57 (38%) had patient factors that likely contributed to the diagnostic delay or apparent failure to screen/offer to screen.ConclusionMissed opportunities for earlier CRC diagnosis were frequent. Additional studies of clinical data management, focusing on following up abnormal findings, and offering/completing CRC screening, are needed.

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