Screening Compliance Rate Research Articles

Breast cancer screening in women with cerebral palsy: Could care delivery be improved?

BackgroundWomen with disabilities (WWD) have reported lower mammography rates than the general population, however rates for women with cerebral palsy (CP) have not been specifically studied. ObjectiveTo evaluate mammography rates in women with CP and to identify strengths and barriers with their screening experience. MethodsWomen with CP 40 years or older (n = 118) participating in a prospective cross-sectional survey were queried regarding screening status, imaging modality, and accommodation needs and availability. Categorical variables were summarized and Chi-square testing used to assess factors contributing to screening compliance. The effect of functional factors on screening was evaluated using logistic regression. Results77 women (65.3%) had mammograms within the past two years; 56 (47.5%) were screening mammograms. Severity of fine motor deficits was associated with lack of screening (OR 0.559, p = 0.019). 85 (72.0%) experienced positive staff attitudes. Facilities most often met needs for ramps, elevators, and/or wide doorways (92.9%), exam explanations (84.4%), and accessible parking (82.5%). Needs least often met included accommodations for standing (59.3%) or for difficulties with arm/shoulder positioning (57.1%), and wheelchair-accessible mammogram machines (59.1%). ConclusionsThe screening compliance rate for women with CP is low, although the 2-year mammography rate is comparable to that reported for WWD and the general female U.S. population. Women were usually offered respectful care. Adequate physical accommodations during the procedure were reported less often than overall facility environmental accommodations. These findings demonstrate the need for improved screening rates in women with CP, and highlight areas for improving their screening experience.

Improving Colorectal Polyp Classification Based on Physical Examination Data—An Ensemble Learning Approach

Colorectal cancer is a common type of cancer. Due to the alarming incidence and mortality rate, it has received increasing attention on early detection and treatment. Colorectal polyps form and grow at initial stages of most colorectal cancer cases. Due to rather stringent medical resource availability and low screening compliance rate, it is more desirable in China than industrialized countries to characterize the relations between colorectal polyp occurrence and various potential determinants, including basic health information, comorbidities, and lifestyle conditions. Subsequently, one can better predict polyp incidence for each individual. In this letter, we report a data-driven modeling study to improve binary classification of colorectal polyp occurrence. We apply several machine-learning methods, particularly random forests, for physical examination and screening colonoscopy results of a Chinese cohort, to build the classifiers. Our results suggest improved prediction performance with the random forests model. Our study also provides evidence to support the general speculation that emotional status may be an influential risk factor to early colorectal cancer growth in China.

Estimating Cost-effectiveness of a Multimodal Ovarian Cancer Screening Program in the United States

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is the largest randomized clinical trial to evaluate screening's impact on ovarian cancer mortality, assigning women to multimodal screening (MMS) with serum cancer antigen 125 (CA-125) interpreted using a risk algorithm. If the MMS screening method is eventually shown to reduce mortality and be cost-effective, then it may be accepted by the medical community as a feasible screening tool. To estimate the cost-effectiveness of an MMS screening program in the United States. A Markov simulation model was constructed using data from UKCTOCS to compare MMS with no screening in the United States. Screening would begin at the age of 50 years for women in the general population. Published estimates of the long-term effect of MMS screening on ovarian cancer mortality and the trial's published hazard ratios were used to simulate mortality estimates up to 40 years from start of screening. Base-case costs included CA-125, ultrasound, and false-positive work-up results, in addition to a risk algorithm cost estimate of $100. The utility and costs of ovarian cancer treatment were incorporated into the model. Screening strategies varied by costs of the algorithm and treatment for advanced ovarian cancer, rates of screening compliance, ovarian cancer incidence, and extrapolation of ovarian cancer mortality. Costs, quality-adjusted life-years (QALYs), and mortality reduction of ovarian cancer screening. Multimodal screening is both more expensive and more effective in reducing ovarian cancer mortality over a lifetime than no screening. After accounting for uncertainty in the underlying parameters, screening women starting at age 50 years with MMS is cost-effective 70% of the time, when decision makers are willing to pay $150 000 per QALY. Screening reduced mortality by 15%, with an incremental cost-effectiveness ratio (ICER) ranging from $106 187 (95% CI, $97 496-$127 793) to $155 256 (95% CI, $150 369-$198 567). Ovarian cancer screening is potentially cost-effective in the United States depending on final significance of mortality reduction and cost of the CA-125 risk algorithm. These results are limited by uncertainty around the effect of screening on ovarian cancer mortality beyond the 11 years of UKCTOCS.

Cost-effectiveness analysis on colorectal cancer screening program

Objective: To evaluate the cost-effectiveness of colorectal cancer screening program in different age groups from the view of health economics. Methods: The screening compliance rates, detection rates in different age groups were calculated by using the data from colorectal cancer screening program in Jiashan county, Zhejiang province. The differences in indicator among age groups were analyzed with χ(2) test or trend χ(2) test. The ratios of cost to the number of case were calculated according to cost statistics. Results: The detection rates of immunochemical fecal occult blood test (iFOBT) positivity, advanced adenoma and colorectal cancer and early stage cancer increased with age, while the early diagnosis rates were negatively associated with age. After exclusion the younger counterpart, the cost-effectiveness of individuals aged >50 years could be reduced by 15%-30%. Conclusion: From health economic perspective, it is beneficial to start colorectal cancer screening at age of 50 years to improve the efficiency of the screening.

Audit of Pulse Oximetry Screening for Critical Congenital Heart Disease (Cchd) in Newborns

Abstract BACKGROUND: UK data suggests that 25% of infants with CCHD are not diagnosed with heart disease until after discharge from the nursery (0.6 per 1000). In general SpO2 ≤ to 95% or a difference of upper and lower SpO2 of more than 3% in a newborn greater than 24 hours of age is considered significant. In March 2014 the Maternal Child Newborn Screening Committee of the Provincial Council for Maternal Child Health (PCMCH) recommended screening for critical congenital heart disease in Ontario. OBJECTIVES: To assess the efficacy and cost related parameters of a new screening protocol for CCHD. DESIGN/METHODS: An audit of consecutive healthy normal newborn patients over a one-year period was undertaken. RESULTS: The cost of screening estimated for our center was approximately $7.20 per patient. The median age of screening was 25 hours (6-80 hours). Four patients were screened positive and were seen by a paediatrician in consultation. No Echocardiograms were ordered. No child in this screening survey had CCHD (specificity 99.4%). The screening compliance was 94.7%. One patient from our regional catchment area was delivered at an alternate secondary level center where there is no CCHD protocol in effect. The infant was discharged home and returned to the primary level center two days later in shock. The ultimate diagnosis was Hypoplastic Left Heart Syndrome. The estimated cost of the resuscitation was $1000. The emergency transport (direct) cost for this unstable newborn by helicopter is estimated to be $5000.00. Conclusion: Cost analysis: The total direct costs of the CCHD screening program for a year is approximately $5200. The costs for the four patients who were falsely identified as having CCHD is estimated at $200. The total direct cost to the system of the one patient in our region who was not screened and was subsequently identified as having CCHD was estimated to be $6000. Assessment issues: In contrast to the US references, none of the false positive cases had an echocardiogram ordered. The cases were dealt with by utilizing a consultation with a paediatrician. Compliance with routine newborn orders: The screening compliance rate of 94.7%. CONCLUSIONS: A simple screening test for Critical Congenital Heart Disease was successfully undertaken in a secondary level center over a one-year period. The test was cost effective, with high specificity (99.4%) and good compliance (94.7%).

Cost-effectiveness of three-stage newborns hearing screening in Beijing

To evaluate the cost-effectiveness of two-stage and three-stage hearing screenings for newborns. Hearing screening was performed for the normal newborns born in 7 hospitals in Beijing from October 2010 to December 2012 by using two stage and three stage strategies as well as hearing diagnostic test, and the cost effectiveness evaluation of two strategies was conducted. The data about the cost of screening and diagnostic test were from the hospitals. The data about car fare and charge for loss of working time of parents were collected through questionnaire survey. The sensitivity was analyzed according to the compliance rate. A total of 62,695 newborns received initial hearing screening, 5,809 newborns failed, the positive rate was 9.30%. A total of 4,933 newborns received rescreening, 972 newborns failed, the positive rate was 19.70%. Among the newborns failed in rescreening, 412 were provided with hearing diagnostic test and 360 received diagnostic test. The diagnostic test indicated that the hearing of 217 newborns were abnormal (60.28%). A total of 276 newborns received the third screening, 163 newborns failed, in which 125 received diagnostic test and 112 had abnormal hearing (45 had moderate and above hearing impairment), the abnormal rate was 89.60%. The average cost for three-stage screening (37,242 yuan RMB per case) was higher than that for two-stage screening (19,985 yuan RMB per case). With the increase of compliance, the cost-effectiveness of three-stage screening increased. The cost-effectiveness of three-stage screening was influenced by screening compliance. It is recommended that three-stage screening strategy might be taken in area where the screening compliance rate is >90%.

Rapid Grading of Fundus Photographs for Diabetic Retinopathy Using Crowdsourcing

BackgroundScreening for diabetic retinopathy is both effective and cost-effective, but rates of screening compliance remain suboptimal. As screening improves, new methods to deal with screening data may help reduce the human resource needs. Crowdsourcing has been used in many contexts to harness distributed human intelligence for the completion of small tasks including image categorization.ObjectiveOur goal was to develop and validate a novel method for fundus photograph grading.MethodsAn interface for fundus photo classification was developed for the Amazon Mechanical Turk crowdsourcing platform. We posted 19 expert-graded images for grading by Turkers, with 10 repetitions per photo for an initial proof-of-concept (Phase I). Turkers were paid US $0.10 per image. In Phase II, one prototypical image from each of the four grading categories received 500 unique Turker interpretations. Fifty draws of 1-50 Turkers were then used to estimate the variance in accuracy derived from randomly drawn samples of increasing crowd size to determine the minimum number of Turkers needed to produce valid results. In Phase III, the interface was modified to attempt to improve Turker grading.ResultsAcross 230 grading instances in the normal versus abnormal arm of Phase I, 187 images (81.3%) were correctly classified by Turkers. Average time to grade each image was 25 seconds, including time to review training images. With the addition of grading categories, time to grade each image increased and percentage of images graded correctly decreased. In Phase II, area under the curve (AUC) of the receiver-operator characteristic (ROC) indicated that sensitivity and specificity were maximized after 7 graders for ratings of normal versus abnormal (AUC=0.98) but was significantly reduced (AUC=0.63) when Turkers were asked to specify the level of severity. With improvements to the interface in Phase III, correctly classified images by the mean Turker grade in four-category grading increased to a maximum of 52.6% (10/19 images) from 26.3% (5/19 images). Throughout all trials, 100% sensitivity for normal versus abnormal was maintained.ConclusionsWith minimal training, the Amazon Mechanical Turk workforce can rapidly and correctly categorize fundus photos of diabetic patients as normal or abnormal, though further refinement of the methodology is needed to improve Turker ratings of the degree of retinopathy. Images were interpreted for a total cost of US $1.10 per eye. Crowdsourcing may offer a novel and inexpensive means to reduce the skilled grader burden and increase screening for diabetic retinopathy.

Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access

ObjectiveTo estimate the prevalence of, and factors associated with, dilated eye examination guideline compliance among patients with diabetes mellitus (DM), but without diabetic retinopathy.Research design and methodsUtilizing the computerized billing...

Using a partially observable Markov chain model to assess colonoscopy screening strategies – A cohort study

Colorectal cancer (CRC) is notoriously hard to combat for its high incidence and mortality rates. However, with improved screening technology and better understanding of disease pathways, CRC is more likely to be detected at early stage and thus more likely to be cured. Among the available screening methods, colonoscopy is most commonly used in the U.S. because of its capability of visualizing the entire colon and removing the polyps it detected. The current national guideline for colonoscopy screening recommends an observation-based screening strategy. Nevertheless, there is scant research studying the cost-effectiveness of the recommended observation-based strategy and its variants. In this paper, we describe a partially observable Markov chain (POMC) model which allows us to assess the cost-effectiveness of both fixed-interval and observation-based colonoscopy screening strategies. In our model, we consider detailed adenomatous polyp states and estimate state transition probabilities based on longitudinal clinical data from a specific population cohort. We conduct a comprehensive numerical study which investigates several key factors in screening strategy design, including screening frequency, initial screening age, screening end age, and screening compliance rate. We also conduct sensitivity analyses on the cost and quality of life parameters. Our numerical result demonstrates the usability of our model in assessing colonoscopy screening strategies with consideration of partial observation of true health states. This research facilitates future design of better colonoscopy screening strategies.

Abstract FO02-01: Community-based interventions to reduce for colon cancer disparites in African Americans in South Carolina.

Abstract FO02-01: Community-based interventions to reduce for colon cancer disparites in African Americans in South Carolina.

Nasal Swab Screening for Methicillin-Resistant Staphylococcus aureus—How Well Does It Perform? A Cross-Sectional Study

To determine the proportion of methicillin-resistant Staphylococcus aureus (MRSA) detections identified by nasal swabbing using agar culture in comparison with multiple body site testing using agar and nutrient broth culture. Cross-sectional study. Adult patients admitted to 36 general specialty wards of 2 large hospitals in Scotland. Patients were screened for MRSA via multiple body site swabs (nasal, throat, axillary, perineal, and wound/invasive device sites) cultured individually on chromogenic agar and pooled in nutrient broth. Combined results from all sites and cultures provided a gold-standard estimate of true MRSA prevalence. This study found that nasal screening performed better than throat, axillary, or perineal screening but at best identified only 66% of true MRSA carriers against the gold standard at an overall prevalence of 2.9%. Axillary screening performed least well. Combining nasal and perineal swabs gave the best 2-site combination (82%). When combined with realistic screening compliance rates of 80%-90%, nasal swabbing alone probably detects just over half of true colonization in practice. Swabbing of clinically relevant sites (wounds, indwelling devices, etc) is important for a small but high-prevalence group. Nasal swabbing is the standard method in many locations for MRSA screening. Its diagnostic efficiency in practice appears to be limited, however, and the resource implications of multiple body site screening have to be balanced against a potential clinical benefit whose magnitude and nature remains unclear.

An 18-gene blood-based IVD test for colorectal cancer early detection with high sensitivity and specificity.

3551 Background: Colorectal cancer (CRC) is often curable particularly diagnosed at early stages. Different screening strategies are in place in various counties. However, the compliance rate with current CRC screening recommendations remains poor. A simple blood-based IVD test would represent an interesting alternative. We previously reported a 100-gene signature for early detection of CRC using microarray technology. Based on this result, we have developed a new blood test with real-time PCR technology. Methods: 144 CRC cases and 153 Controls were enrolled. A total of 52 genes were selected as candidate markers to be transferred from microarray to real-time PCR. The gene expression profiles from 100 CRC cases and 100 Controls were used as a training set for signature discovery. Signature identification process was conducted by Minimum Redundancy Maximum Relevance (mRMR) feature selection method and Support Vector Machine (SVM) classification algorithm under the Leave-One-Out Cross Validation (LOOCV) framework. The optimal size of signature was determined by a stepwise inclusion selection procedure which started with one gene and repeatedly added genes one by one until all genes were included. The performance of each N-gene signature by the LOOCV was estimated and used to determine the best size of signature. Results: The gene expression profiles measured by microarray and real-time PCR technology were highly comparable and resulted in a significant correlation in term of fold change ratio between CRC cases and Controls (Pearson’s Correlation Coefficient = 0.95). An 18-gene signature was identified and validated in an independent validation set with 44 CRC cases and 53 Controls. The performance of 18-gene signature in the validation set reached 88.7% accuracy (95%CI: 0.80-0.94), 88.6% sensitivity (95%CI: 0.75-0.96), and 88.7% specificity (95%CI: 0.76-0.95). Conclusions: Our new results demonstrated the feasibility of technology transfer from microarray to real-time PCR. The blood test could be offered to individuals who are unwilling or unable to undergo colonoscopy to increase the CRC screening compliance rate. Meanwhile, its high specificity could also help to avoid unnecessary colonoscopies.

Postpartum Depression Screening

Postpartum depression (PPD) has emerged as an important issue for pediatricians and family practitioners because of detrimental effects on children. PPD occurs in 10% to 22% of women who have recently given birth, but fewer than half of cases are recognized. Despite the impact of PPD, many primary care clinicians do not have systemic screening approaches implemented. This paper will review the development of a screening protocol for PPD in a multispecialty clinic, with the implementation utilizing depression care managers and the preliminary results of our process. Of the 333 screened examinations during the 4-month study, 38.1% (n = 127) were performed for the 2-month well child examination; 33.6% (n = 112) were for the 4-month examination, with 28.2% (n = 94) being performed for the 6-month well child examination. Only 15 (4.5%) were positive for possible depression with a screening compliance rate of 47.9%. No significant difference was noted in the timing of the well child visit with a positive screening test result, nor was there any difference in family medicine versus pediatric colleagues in the utilization of the screening or diagnosis of PPD. Implementation of PPD screening in a multispecialty clinic can be effective, given utilization of depression care managers.

Routine PHQ-9 Depression Screening in Home Health Care: Depression Prevalence, Clinical and Treatment Characteristics, and Screening Implementation

ABSTRACT This study aimed to examine: the prevalence and correlates of depression among adults age 65 and over on admission to diverse home health care programs; nurse compliance with routine screening using the PHQ-9; and concordance between the number of depressed individuals identified by the PHQ-9 and Medicare-mandated nursing assessment following targeted nurse training in identifying depression among the elderly using a standard diagnostic screen. Data are drawn from routine screening of 9,178 patients (a 77% screening compliance rate). Of all patients screened, 782 (8.5%) met criteria for probable major depression and 148 (1.6%) for mild depression. Concordance between nurse identified depression via PHQ-9 vs OASIS depression assessment improved over that reported in previous studies. Findings suggest that the use of a routine screening tool for depression can be implemented with minimal in-house training and improves detection of depression among older adults with significant physical and functional impairment.

A survey of compliance: Medicaid's mandated blood lead screenings for children age 12-18 months in Nebraska.

BackgroundTo determine the frequency of Medicaid mandated blood lead level (BLL) screening compliance rates by clinical site.MethodsRetrospective chart review for evidence of BLLs. Data analyses were conducted using frequencies, percentages & chi-square.ResultsThe overall incidence of documented BLLs was 78.9% with one clinic demonstrating 100% BLLs while the others had 72%. Screening rates differed significantly by clinical site (X2 = 18.460, df = 3, p < 0.001).ConclusionAlthough universal blood lead screening is mandated, there were missed opportunities to obtain BLLs in 21.1% of the records reviewed. Only one clinic had 100% documentation of BLLs when children on Medicaid were seen between the ages of 12–18 months.

Participation and screening programmes for colorectal cancer: More would be better?

In clinical terms, a screening compliance rate of 100% may be deemed optimal in that the number of abnormalities detected is thereby maximized. This paper explores optimum compliance rates from the cost-effectiveness point of view by modelling the individual's decision to participate in the screening programme. Using data derived from contemporary colorectal screening trials, it assesses the compliance and cost effects of utilizing differing methods of screening invitation, and explores the incremental cost and benefits associated with compliance enhancement techniques. Given the estimated costs and benefits, attempts to attain higher levels of compliance would appear justifiable.