Researchers identified 438 patients with rectal bleeding, hemorrhoids and blood in the stool at 10 adult primary care practices in Boston. Physician reviewers examined processes of care, overall quality of care as well as measures that could have reduced or prevented a delayed workup.
Overall, the reviewers judged quality of care to be good or excellent in 77 percent of the cases. However, 71 percent of patients experienced at least one process-of-care failure in the workup for rectal bleeding. Additionally, physicians did not:
• Obtain an adequate family history in 38 percent of cases
• Conduct a proper physical exam in 23 percent of cases
• Order laboratory tests in 16 percent of cases
Around 128 delays in workup could have been reduced or prevented, the reviewers noted.
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