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Background <p>Completion of follow-up colonoscopy after a positive stool-based test varies across health settings. Colonoscopy performed &gt; 6&#xa0;months following a positive stool test is associated with adverse colorectal cancer outcomes.</p> Methods <p>This retrospective study included 701 patients aged 45–75 in an urban, integrated health system with a positive stool test between February 1, 2022, and January 31, 2023. We examined rates of timely (i.e., within 180&#xa0;days) follow-up colonoscopy and at varying time points (90&#xa0;days, 365&#xa0;days, and any time during our follow-up period). Multivariable Cox proportional hazard models examined factors associated with timely colonoscopy, and a Pareto analysis identified barriers to timely completion.</p> Results <p>The median age of this cohort was 64&#xa0;years (IQR 56–70); 52.1% were female, 48.2% were non-Hispanic White, and 52.4% had a Charlson Comorbidity Index score ≥ 3. The rate of timely follow-up colonoscopy was 59.6%, with rates of 44.5% and 68.5% at 90&#xa0;days and 365&#xa0;days, respectively. In Cox models, patient outreach increased timely colonoscopy by 52% (HR 1.52, 95% CI 1.21–1.91), while Direct Access patients were less likely to complete timely colonoscopy (HR 0.59, 95% CI 0.41–0.86); no associations were observed with sociodemographic factors. The most common barriers to timely colonoscopy were (1) lack of gastroenterology clinic visit, (2) patient refusal, and (3) colonoscopy no-show or cancellation.</p> Conclusions <p>The rate of timely, follow-up colonoscopy in this older, sicker population is suboptimal. System-level factors impact timely completion. A Pareto analysis reveals multiple elements that contribute to delays in colonoscopy and can inform interventions.</p>

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Rates and Timing of Follow-up Colonoscopy After a Positive Stool-Based Test in an Integrated Health System

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月26日

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  • Christina P. Wang,
  • Ankit M. Shah,
  • Matthew Y. Zhao,
  • Ji Yoon Yoon,
  • Michelle Zhao,
  • Yuhong Yang,
  • Tsion Tmariam,
  • Lina H. Jandorf,
  • Steven H. Itzkowitz

摘要

Background

Completion of follow-up colonoscopy after a positive stool-based test varies across health settings. Colonoscopy performed > 6 months following a positive stool test is associated with adverse colorectal cancer outcomes.

Methods

This retrospective study included 701 patients aged 45–75 in an urban, integrated health system with a positive stool test between February 1, 2022, and January 31, 2023. We examined rates of timely (i.e., within 180 days) follow-up colonoscopy and at varying time points (90 days, 365 days, and any time during our follow-up period). Multivariable Cox proportional hazard models examined factors associated with timely colonoscopy, and a Pareto analysis identified barriers to timely completion.

Results

The median age of this cohort was 64 years (IQR 56–70); 52.1% were female, 48.2% were non-Hispanic White, and 52.4% had a Charlson Comorbidity Index score ≥ 3. The rate of timely follow-up colonoscopy was 59.6%, with rates of 44.5% and 68.5% at 90 days and 365 days, respectively. In Cox models, patient outreach increased timely colonoscopy by 52% (HR 1.52, 95% CI 1.21–1.91), while Direct Access patients were less likely to complete timely colonoscopy (HR 0.59, 95% CI 0.41–0.86); no associations were observed with sociodemographic factors. The most common barriers to timely colonoscopy were (1) lack of gastroenterology clinic visit, (2) patient refusal, and (3) colonoscopy no-show or cancellation.

Conclusions

The rate of timely, follow-up colonoscopy in this older, sicker population is suboptimal. System-level factors impact timely completion. A Pareto analysis reveals multiple elements that contribute to delays in colonoscopy and can inform interventions.