Clinical Use of CT Colonography for Colorectal Cancer Screening in Military Training Facilities and Potential Impact on HEDIS Measures

Purpose: The National Committee for Quality Assurance developed the Healthcare Effectiveness Data and Information Set (R) (HEDIS (R)) to provide quality measures for the evaluation of standards of medical care across health plans. Screening for colorectal cancer (CRC) has been shown to increase the detection of early-stage disease and reduce mortality. Current HEDIS measures for CRC screening include fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy. The aim of this analysis was to quantify the use of CT colonography (CTC) for CRC screening and demonstrate the potential impact of including CTC as a HEDIS-acceptable screening modality. Methods: Demographic and health care utilization data from the Military Health System Population Health Portal for January 1, 2005, through December 31, 2010, for individuals aged 50 to 75, were analyzed to determine the degree of overall utilization of CTC. Screening compliance for CRC per HEDIS was also estimated, and the incremental impact of adding HEDIS-eligible patients who had undergone CTC as their only CRC screening test was then evaluated for two similarly sized, regional Navy medical centers. Results: Across all sites (10 Army, 4 Navy, 3 Air Force), 17, 187 CTC studies were performed, with increasing utilization during the 6-year study period. At the two Navy medical centers, screening compliance ranged from 33.8% to 67.9% without CTC and from 33.8% to 84.0% with CTC. Conclusions: CTC is actively being used for CRC screening across military treatment facilities. The inclusion of CTC as a HEDIS-compliant CRC screening test has the potential to significantly increase health care system compliance for National Committee for Quality Assurance CRC screening measures.