wow-inequalities/02-data/intermediate/wos_sample/6d59abdb7c97cb8c909ae6d9d4202199-sharma-anjana-e.-an/info.yaml

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2023-09-28 14:46:10 +00:00
abstract: 'Objectives Safety-net health care systems, serving vulnerable
populations, see longer delays to timely colonoscopy after a positive
fecal occult blood test (FOBT), which may contribute to existing
disparities. We sought to identify root causes of colonoscopy delay
after positive FOBT result in the primary care safety net. Methods We
conducted a multisite root cause analysis of cases of delayed
colonoscopy, identifying cases where there was a delay of greater than 6
months in completing or scheduling a follow-up colonoscopy after a
positive FOBT. We identified cases across 5 California health systems
serving low-income, vulnerable populations. We developed a
semistructured interview guide based on precedent work. We conducted
telephone individual interviews with primary care providers (PCPs) and
patients. We then performed qualitative content analysis of the
interviews, using an integrated inductive-deductive analytic approach,
to identify themes related to recurrent root causes of colonoscopy
delay. Results We identified 12 unique cases, comprising 5 patient and
11 PCP interviews. Eight patients completed colonoscopy; median time to
colonoscopy was 11.0 months (interquartile range, 6.3 months). Three
patients had advanced adenomatous findings. Primary care providers
highlighted system-level root causes, including inability to track
referrals between primary care and gastroenterology, lack of protocols
to follow up with patients, lack of electronic medical record
interoperability, and lack of time or staffing resources, compelling
tremendous additional effort by staff. In contrast, patients''
highlighted individual-level root causes included comorbidities, social
needs, and misunderstanding the importance of the FOBT. There was a
little overlap between PCP and patient-elicited root causes. Conclusions
Current protocols do not accommodate communication between primary care
and gastroenterology. Interventions to address specific barriers
identified include improved interoperability between PCP and
gastroenterology scheduling systems, protocols to follow-up on
incomplete colonoscopies, accommodation for support and transport needs,
and patient-friendly education. Interviewing both patients and PCPs
leads to richer analysis of the root causes leading to delayed diagnosis
of colorectal cancer.'
affiliation: 'Sharma, AE (Corresponding Author), 995 Potrero Ave,Ward 83, San Francisco,
CA 94110 USA.
Sharma, Anjana E., Univ Calif San Francisco, Dept Family \& Community Med, San Francisco,
CA 94143 USA.
Sharma, Anjana E.; Lyson, Helena C.; Cherian, Roy; Somsouk, Ma; Schillinger, Dean;
Sarkar, Urmimala, UCSF, Ctr Vulnerable Populat, San Francisco, CA USA.
Lyson, Helena C.; Schillinger, Dean; Sarkar, Urmimala, UCSF, Div Gen Internal Med,
San Francisco, CA USA.
Somsouk, Ma, UCSF Sch Med, Dept Gastroenterol, San Francisco, CA USA.'
author: Sharma, Anjana E. and Lyson, Helena C. and Cherian, Roy and Somsouk, Ma and
Schillinger, Dean and Sarkar, Urmimala
author-email: Anjana.sharma@ucsf.edu
author_list:
- family: Sharma
given: Anjana E.
- family: Lyson
given: Helena C.
- family: Cherian
given: Roy
- family: Somsouk
given: Ma
- family: Schillinger
given: Dean
- family: Sarkar
given: Urmimala
da: '2023-09-28'
doi: 10.1097/PTS.0000000000000718
eissn: 1549-8425
files: []
issn: 1549-8417
journal: JOURNAL OF PATIENT SAFETY
keywords: 'colorectal neoplasms; delayed diagnosis; primary health care; root cause
analysis'
keywords-plus: COLORECTAL-CANCER; RACIAL DISPARITIES; FOLLOW-UP; MEDICAID; STAGE
language: English
month: JAN
number: '1'
number-of-cited-references: '29'
pages: E163-E171
papis_id: b296009f709c886442f182418169ca4a
ref: Sharma2022rootcause
times-cited: '9'
title: A Root Cause Analysis of Barriers to Timely Colonoscopy in California Safety-Net
Health Systems
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000733885200030
usage-count-last-180-days: '2'
usage-count-since-2013: '9'
volume: '18'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2022'