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
type: article
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'