The quality of colonoscopy services--responsibilities of referring clinicians: a consensus statement of the Quality Assurance Task Group, National Colorectal Cancer Roundtable.

Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 11/2010; 25(11):1230-4.
Source: PubMed


Primary care clinicians initiate and oversee colorectal screening for their patients, but colonoscopy, a central component of screening programs, is usually performed by consultants. The accuracy and safety of colonoscopy varies among endoscopists, even those with mainstream training and certification. Therefore, it is a primary care responsibility to choose the best available colonoscopy services. A working group of the National Colorectal Cancer Roundtable identified a set of indicators that primary care clinicians can use to assess the quality of colonoscopy services. Quality measures are of actual performance, not training, specialty, or experience alone. The main elements of quality are a complete report, technical competence, and a safe setting for the procedure. We provide explicit criteria that primary care physicians can use when choosing a colonoscopist. Information on quality indicators will be increasingly available with quality improvement efforts within the colonoscopy community and growth in the use of electronic medical records.

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    • "However, most such databases either do not have a screening colonoscopy procedure code or the code is underused since the primary purpose is remuneration [21,23]. Methods to distinguish screening and non-screening colonoscopies would enable monitoring of CRC screening uptake, tracking of health resource utilization, and estimation of cost-effectiveness; they may also be used for quality assessment as a key quality indicator is the adenoma detection rate in screening colonoscopies [22,24,25]. Automated data screening colonoscopy algorithms developed in previous studies had sensitivities ranging between 29% and 84% and specificities ranging between 58% and 93%; none of the algorithms had both high sensitivity and specificity [7,12,13], which led to the conclusion that administrative data cannot reliably be used to distinguish between colonoscopy indications [7,26]. "
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    ABSTRACT: Background Algorithms to identify screening colonoscopies in administrative databases would be useful for monitoring colorectal cancer (CRC) screening uptake, tracking health resource utilization, and quality assurance. Previously developed algorithms based on expert opinion were insufficiently accurate. The purpose of this study was to develop and evaluate the accuracy of model-based algorithms to identify screening colonoscopies in health administrative databases. Methods Patients aged 50-75 were recruited from endoscopy units in Montreal, Quebec, and Calgary, Alberta. Physician billing records and hospitalization data were obtained for each patient from the provincial administrative health databases. Indication for colonoscopy was derived using Bayesian latent class analysis informed by endoscopist and patient questionnaire responses. Two modeling methods were used to fit the data, multivariate logistic regression and recursive partitioning. The accuracies of these models were assessed. Results 689 patients from Montreal and 541 from Calgary participated (January to March 2007). The latent class model identified 554 screening exams. Multivariate logistic regression predictions yielded an area under the curve of 0.786. Recursive partitioning using the latent outcome had sensitivity and specificity of 84.5% (95% CI: 81.5-87.5) and 63.3% (95% CI: 59.7-67.0), respectively. Conclusions Model-based algorithms using administrative data failed to identify screening colonoscopies with sufficient accuracy. Nevertheless, the approach of constructing a latent reference standard against which model-based algorithms were evaluated may be useful for validating administrative data in other contexts where there lacks a gold standard.
    BMC Medical Informatics and Decision Making 04/2013; 13(1):45. DOI:10.1186/1472-6947-13-45 · 1.83 Impact Factor
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    ABSTRACT: Primary care physicians initiate colorectal cencer (CRC) screening and manage health care issues that present from these procedures. Quality of colonoscopy services can be determined by a set of indicators. The purpose of this study was to identify the quality of colonoscopy services provided for patients of family physicians in the Iowa Research Network (IRENE). Quality of services was delineated by (1) presence of a colonoscopy report on the medical record, if the medical record indicated a colonoscopy had been completed, (2) cecal intubation rate, (3) adenoma detection rate, and (4) the content of the colonoscopy report. Medical record review was conducted in 14 IRENE offices. Of 581 medical records indicating a colonoscopy had been completed, 89 (15%) did not have a colonoscopy report. The main reasons for having the colonoscopy were screening and obvious blood in the stool. Polyp detection rate for all colonoscopies was 35%, and the adenoma detction rate for screening colonoscopis for men was 31% and for women was 19%. Depth of insertion to the cecum was reached for 92%. Items least mentioned in the report were the time to complete the procedure and current medications. Only 223 (45%) reports listed the follow-up interval for next colonoscopy. Quality of colonoscopy services for this group of IRENE physicians was comparable to recommended standards of depth of insertion and adenoma detection rate. Improvements are warranted to have all colonoscopy reports and follow-up interval of next colonoscopy on a patient's medical record.
    Family medicine 03/2012; 44(3):164-70. · 1.17 Impact Factor
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    ABSTRACT: Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths estimated in 2012. To explore further the social inequalities in colorectal cancer mortality, we used fundamental cause theory to consider the role of societal diffusion of information and socioeconomic status. Methods: We used the number of deaths from colorectal cancer in U.S. counties between 1968 and 2008. Through geographical mapping, we examined disparities in colorectal cancer mortality as a function of socioeconomic status and the rate of diffusion of information. In addition to providing year-specific trends in colorectal cancer mortality rates, we analyzed these data using negative binomial regression. Findings: The impact of socioeconomic status (SES) on colorectal cancer mortality is substantial, and its protective impact increases over time. Equally important is the impact of informational diffusion on colorectal cancer mortality over time. However, while the impact of SES remains significant when concurrently considering the role of diffusion of information, the propensity for faster diffusion moderates its effect on colorectal cancer mortality. Conclusions: The faster diffusion of information reduces both colorectal cancer mortality and inequalities in colorectal cancer mortality, although it was not sufficient to eliminate SES inequalities. These findings have important long-term implications for policymakers looking to reduce social inequalities in colorectal cancer mortality and other, related, preventable diseases.
    Milbank Quarterly 09/2012; 90(3):592-618. DOI:10.1111/j.1468-0009.2012.00675.x · 3.38 Impact Factor
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