Concept: Colorectal Cancer Screening / Fecal Occult Blood Test (FOBT)

Introduction

This concept describes how colorectal cancer screening / fecal occult blood tests (FOBT) are identified using data from the MCHP Data Repository, identifies where this has been used in MCHP research, and provides access to the results and discussion of this research.

Colorectal Cancer Screening / Fecal Occult Blood Test (FOBT) - Defined

In the deliverable A Comparison of Models of Primary Care Delivery in Winnipeg by Katz et al. (2016), they developed and investigated 29 primary care quality indicators. One of those indicators was colorectal cancer screening for adults aged 50-74, using rates of fecal occult blood tests (FOBT) as the measure. The indicator "colorectal cancer screening" was defined as the proportion of patients aged 50-74 who had at least one FOBT in a two-year period (fiscal years 2011/12 to 2012/2013). The analyses included FOBT records from the CancerCare Manitoba Colon Check and Medical Claims databases. Tests for non-screening purposes were excluded.

The technical definition, available in Appendix 1 - Primary Care Quality Indicator Definitions, is as follows:


• patients aged 50-74 who had at least one Fecal Occult Blood Test (FOBT) in a two-year period (fiscal years 2011/12-2012/13). FOBTs were defined using the tariff code 9374 from the Medical Services / Physician Claims data.
  
• patients with a history of colorectal cancer were excluded, using the data from CancerCare Manitoba.

Additional exclusions included:


• FOBTs done in hospital;
  
• FOBTs done within 6 months of a GI complaint;
  
• FOBTs done within 6 months of a colonoscopy, barium enema, or flexible sigmoidoscopy; and
  
• FOBTs done within 1 year of a previous FOBT.
  
• Multiple FOBTs within the past year was excluded in Katz et al. (2019).

Research Results and Discussion

In the deliverable A Comparison of Models of Primary Care Delivery in Winnipeg by Katz et al. (2016), they investigated the relationships between primary care quality indicators and models of primary care delivery and social complexities.

For more information on the results and discussion related to the primary care quality indicator "colorectal cancer screening", please read the section titled: Colorectal Cancer Screening for Adults Aged 50-74. This section also contains the following tables and figure:


• Table 4.7: Eligible Population and Crude Rate of Colorectal Cancer Screening;
  
• Table 4.8: Comparison Between Models of Primary Care: Colorectal Cancer Screening;
  
• Table 4.9: Relationship Between Social Complexities and Colorectal Cancer Screening
  
• Figure 4.2: Relationship Between the Number of Social Complexities and Colorectal Cancer Screening

Additional information / results regarding colorectal cancer screening found in this research includes:


• Online Appendix Table 2.3: Colorectal Cancer Screening: Adults Aged 50-74, Population and Crude Rate - contains a count of the eligible population and the crude rate for each clinic within each model of primary care (excluding the Non-PIN FFS clinics).
  
• Online Appendix Table 3.3: Statistical Model Output for Colorectal Cancer Screening: Adults Aged 50-74 - contains the odds ratio (95% confidence limits) and p-value for each of the effects investigated. This includes several effects in each of the following categories: model of primary care comparisons, patient and provider characteristics, and social complexity.


In the deliverable The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba by Katz et al. (2019), they investigated colorectal cancer screening rates by; RHA (On and Off reserve First Nations vs all other Manitobans), On Reserve First Nations by Tribal Council Area, Income Quintile (On and Off reserve First Nations vs other Manitobans).

For more information, please see: Fecal Occult Blood Tests (Colorectal Cancer Screening) in Katz et al. (2019) deliverable and Technical Definitions of Indicators and Drug Codes from online supplement material from Katz et al. (2019) deliverable.

Data Cautions / Limitations

Colorectal screening / fecal occult blood test (FOBT) data can be found in several data sources (e.g. Medical Services / Medical Claims, laboratory tests, CancerCare Manitoba screening program data). If using more than one data source, please check for duplication to avoid over counting.