ArticleJournal of general internal medicine2026
Rates and Timing of Follow-up Colonoscopy After a Positive Stool-Based Test in an Integrated Health System.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCompletion 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.
methodsThis 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.
resultsThe 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.
conclusionsThe 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.
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