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VA cancer screening reminder falls short: study

By Andrew M. Seaman

NEW YORK (Reuters Health) - An electronic reminder notifying doctors when patients need a colorectal cancer screening accomplished nothing to increase screening rates in a large new study.

"It's a wash," said lead author John Bian, of his group's findings based on the Oncology Watch system that was implemented at eight U.S. Veteran Affairs (VA) hospitals in 2008.

Bian, an associate professor at South Carolina College of Pharmacy in Columbia, and his colleagues write in the Journal of Clinical Oncology that the system was put in place after the federal agency mandated colorectal cancer screenings for all average- and high-risk veterans in 2007.

According to the U.S. Preventive Services Task Force, a government-backed advisory group, people ages 50 to 75 should be screened by one of three methods: a colonoscopy every 10 years; annual stool testing; or a less-thorough look into the colon (known as flexible sigmoidoscopy) every five years in conjunction with stool testing every two to three years.

Colorectal cancer is the third most common cancer in men and women in the U.S., according to the American Cancer Society. It's estimated that about 143,000 people in the U.S. will be diagnosed with the cancer in 2012, and about 52,000 are expected to die from it.

The study's authors write that Oncology Watch was tied into the VA's electronic health record system to accomplish two goals: to increase colorectal cancer screening rates and to improve care with timely diagnosis and surveillance.

To see if the program did those things, Bian and his colleagues looked at colorectal cancer screening rates for average-risk veterans at eight VA hospitals with Oncology Watch, located in Alabama, Georgia and South Carolina.

The researchers analyzed each hospital's screening rates for 2006 and 2007, the two years before Oncology Watch was implemented. They also looked at the two years after the program went into effect, 2009 and 2010.

In addition, they compared those rates to the other 121 VA hospitals without Oncology Watch around the country.

At the centers with the reminders, the researchers found that colorectal cancer screening rates were about 38 percent, 32 percent, 34 percent and 33 percent in 2006, 2007, 2009 and 2010, respectively.

For the same years at the 121 other VA hospitals, the numbers didn't differ that much. Their screening rates were 31 percent, 30 percent, 32 percent and 31 percent.

That works out to a minimal change in screening rates with Oncology Watch, Bian told Reuters Health.

'SYSTEMS ARE IMPLEMENTED BUT RARELY EVALUATED'

"I do think that the message - if there is any nugget in any of this - was that ... there doesn't seem to be any benefit to Oncology Watch," said Dr. Marko Simunovic, who wrote an editorial accompanying the study.

But the only way to prove there's no benefit is to do a randomized controlled trial, Simunovic, of McMaster University in Ontario, told Reuters Health.

As for why Oncology Watch didn't seem to work, the Bian's team speculates it is because reminders simply don't work. They interrupt the doctor's normal work flow and may hurt the quality of care, they write.

Nevertheless, Simunovic thinks more evaluations like this study need to be done because often times policymakers impose rules and it's left for regional hospitals to figure out what does and does not work.

"The main message of this paper is that it takes a lot of money, time and mental resources to implement these sorts of things. And these things are happening all over the place... So systems are implemented but rarely evaluated," he said.

SOURCE: http://bit.ly/RU64Gs and http://bit.ly/SVfOwG Journal of Clinical Oncology, online October 8, 2012.

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