{"article_title":"Working up rectal bleeding in adult primary care practices.","author":"Weingart SN, Stoffel EM, Chung DC, Sequist TD, Lederman RI, Pelletier SR, Shields HM","journal_title":"Journal of evaluation in clinical practice","issn":"1365-2753","isbn":"","publication_date":"2017 Apr","volume":"23","issue":"2","first_page":"279","page_count":"","accession_number":"27436515","doi":"10.1111\/jep.12596","publisher":"Wiley-Blackwell","doctype":"Journal Article","subjects":"Gastrointestinal Hemorrhage etiology; Guideline Adherence; Practice Guidelines as Topic; Primary Health Care organization & administration; Primary Health Care statistics & numerical data; Adult; Aged; Aged, 80 and over; Community Health Centers statistics & numerical data; Diagnostic Techniques and Procedures; Female; Hospitals, Teaching statistics & numerical data; Humans; Male; Medical History Taking; Middle Aged; Physical Examination; Socioeconomic Factors; Urban Health Services statistics & numerical data","interest_area":["Gastroenterology"," Emergency Medicine"," Internal\/Family Medicine"],"abstract":"Rationale, Aims and Objectives: Variation in the workup of rectal bleeding may result in guideline-discordant care and delayed diagnosis of colorectal cancer. Accordingly, we undertook this study to characterize primary care clinicians' initial rectal bleeding evaluation. Methods: We studied 438 patients at 10 adult primary care practices affiliated with three Boston, Massachusetts, academic medical centres and a multispecialty group practice, performing medical record reviews of subjects with visit codes for rectal bleeding, haemorrhoids or bloody stool. Nurse reviewers abstracted patients' sociodemographic characteristics, rectal bleeding-related symptoms and components of the rectal bleeding workup. Bivariate and multivariable logistic regression models examined factors associated with guideline-discordant workups. Results: Clinicians documented a family history of colorectal cancer or polyps at the index visit in 27% of cases and failed to document an abdominal or rectal examination in 21% and 29%. Failure to order imaging or a diagnostic procedure occurred in 32% of cases and was the only component of the workup associated with guideline-discordant care, which occurred in 27% of cases. Compared with patients at hospital-based teaching sites, patients at urban clinics or community health centres had 2.9 (95% confidence interval 1.3-6.3) times the odds of having had an incomplete workup. Network affiliation was also associated with guideline concordance. Conclusion: Workup of rectal bleeding was inconsistent, incomplete and discordant with guidelines in one-quarter of cases. Research and improvements strategies are needed to understand and manage practice and provider variation. \ufffd 2016 John Wiley & Sons, Ltd.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=27436515&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Weingart SN, Stoffel EM, Chung DC, Sequist TD, Lederman RI, Pelletier SR, Shields HM","Journal_Info":"Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE","Publication_Type":"Journal Article","Published_Date":"2017-04-01","Source":"Journal of evaluation in clinical practice [J Eval Clin Pract] 2017 Apr; Vol. 23 (2), pp. 279-287. Date of Electronic Publication: 2016 Jul 20.","Languages":"English","Electronic_ISSN":"1365-2753","MeSH_Terms":"Guideline Adherence* , Practice Guidelines as Topic*, Gastrointestinal Hemorrhage\/*etiology , Primary Health Care\/*organization & administration , Primary Health Care\/*statistics & numerical data, Adult ; Aged ; Aged, 80 and over ; Community Health Centers\/statistics & numerical data ; Diagnostic Techniques and Procedures ; Female ; Hospitals, Teaching\/statistics & numerical data ; Humans ; Male ; Medical History Taking ; Middle Aged ; Physical Examination ; Socioeconomic Factors ; Urban Health Services\/statistics & numerical data","Subjects":"Adult, Aged, Aged, 80 and over, Community Health Centers statistics & numerical data, Diagnostic Techniques and Procedures, Female, Hospitals, Teaching statistics & numerical data, Humans, Male, Medical History Taking, Middle Aged, Physical Examination, Socioeconomic Factors, Urban Health Services statistics & numerical data, Gastrointestinal Hemorrhage etiology, Guideline Adherence, Practice Guidelines as Topic, Primary Health Care organization & administration, Primary Health Care statistics & numerical data","Title_Abbreviations":"Journal of evaluation in clinical practice","Volume":"23"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"27436515","RelevancyScore":"808","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"808.265197753906"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=27436515&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=27436515&authtype=shib&custid=ns346513&group=main&profile=eds"}
