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