Colorectal cancer is an important public health problem in the United States. Despite studies showing that screening can reduce the incidence and mortality of this cancer, epidemiologic data show consistently high numbers of colorectal cancer cases and deaths. Furthermore, a high proportion of cases are being diagnosed at an advanced stage, when treatment is far less effective. These findings suggest that there are problems in the delivery and utilization of colorectal cancer screening. Screening efforts are based in primary care settings and we propose to implement an electronic primary care colorectal cancer screening surveillance system involving the New Mexico Veterans Administration (VA) Health Care System, the University of New Mexico School of Medicine, and the Lovelace Sandia Health System. These organizations are three of the major health care providers in the state of New Mexico, and serve very geographically and ethnically diverse populations. We will use this information system to address objectives of PAR-02-042, Colorectal Cancer in Primary Care Practice, by describing colorectal cancer screening delivery, utilization, efficiency, and outcomes in primary care practices in New Mexico. We will collect colorectal cancer screening and outcome data from electronic clinical and billing files and electronic medical records encompassing the primary care clinics in the three health systems and their associated gastroenterology clinics and pathology labs. Specific data will be collected on patient (demographic, clinical history) and health care system (geographic site, clinic type, provider type, screening programs) characteristics; delivery of colorectal cancer screening tests, including fecal occult blood testing, endoscopic procedures, and radiolologic procedures; patient utilization of these screening services; time intervals from ordering/providing screening and diagnostic tests to test completion/treatment initiation; results of screening and diagnostic testing, including pathologic findings and initial cancer treatment; and the diagnostic performance characteristics of the various colorectal cancer screening tests. These clinical data will be linked to the New Mexico Tumor Registry, a statewide Surveillance Epidemiology and End Results (SEER) registry, to identify prevalent and incident colorectal cancer cases, enabling us to assess screening rates and cancer outcomes. Appropriate statistical tests will be performed to address the study aims, including descriptions of subjects, screening testing rates, proportion of patients currently screened, median time to completion of screening/diagnostic testing and initiating treatment, and the patient and health care system factors associated with these outcomes. We will also evaluate the diagnostic performance of colorectal cancer screening tests, including positive predictive value and yield. In addition to addressing the objectives of the PAR, establishing a primary care colorectal cancer screening surveillance system will also enable us to track the diffusion of future screening interventions into primary care practice and evaluate the effects of health care system changes designed to increase the rate and efficiency of colorectal cancer screening.
