Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured
Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured
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DOI：
10.5888/pcd16.180452
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发表时间：
2019-05-01
影响因子：
5.5
通讯作者：
Shapiro, Jean A.
中科院分区：
文献类型：
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作者：
Nadel, Marion R.;Royalty, Janet;Shapiro, Jean A.
简介筛查可以降低结直肠癌的发病率和死亡率，并在临床实践指南中得到推荐。结直肠癌筛查质量差可能会抵消筛查的益处。本研究的目的是评估疾病控制和预防中心的结直肠癌控制计划从 2009 年 7 月到 2015 年 6 月提供的筛查服务的质量。方法我们从该计划的 29 个受资助者那里收集了数据，这些受资助者为无症状、低收入、保险不足或未保险的 50 至 64 岁成年人提供结直肠癌筛查和诊断服务。我们收集了所有筛查和诊断测试的日期和结果的数据。结果总体而言，82.9%（受资助者范围为 50.0%-97.2%）的阳性 FOBT/FIT 接受了结肠镜检查； 95.2% 的结肠镜检查发生在粪便检测呈阳性后 180 天内。受资助者的盲肠插管率从 94.2% 到 100% 不等。几乎所有受资助者的腺瘤检出率均达到建议的阈值水平。重新筛查和监测间隔的建议在两个方向上都偏离了指南。在结肠镜检查正常的客户中，85.3%（范围为 37.7%-99.7%）被告知按照国家指南的建议在 10 年内返回。在患有晚期腺瘤的客户中，55.2%（范围，20.0%-84.6%）被告知按照建议在 3 年内复诊，25.4%（范围，3.8%-56.6%）在 5 或更长时间内复诊，18.6%（范围，0%-47.2%）在不到 3 年内复诊。 结论 尽管总体筛查质量良好，但差异很大。持续监测以识别绩效问题对于所有结直肠癌筛查活动至关重要，因此旨在提高绩效的工作可以针对个体临床医生。
IntroductionScreening can decrease colorectal cancer incidence and mortality and is recommended in clinical practice guidelines. Poor quality of colorectal cancer screening can negate the benefit of screening. The objective of this study was to assess the quality of screening services provided by the Centers for Disease Control and Prevention's Colorectal Cancer Control Program from July 2009 through June 2015.MethodsWe collected data from the program's 29 grantees, funded to provide colorectal cancer screening and diagnostic services to asymptomatic, low-income, and underinsured or uninsured adults aged 50 to 64. We collected data on the dates and results of all screening and diagnostic tests and, for colonoscopies, on whether the cecum was reached, whether bowel preparation was adequate, and endoscopists' recommendations for the next test.ResultsOverall, 82.9% (range among grantees, 50.0%-97.2%) of positive FOBTs/FITs were followed up by colonoscopy; 95.2% of colonoscopies occurred within 180 days of the positive stool test. Cecal intubation rates ranged among grantees from 94.2% to 100%. Adenoma detection rates met recommended threshold levels for almost all grantees. Recommendations for rescreening and surveillance intervals deviated from guidelines in both directions. Of clients with normal colonoscopies, 85.3% (range, 37.7%-99.7%) were told to return in 10 years, as recommended in national guidelines. Of clients with advanced adenomas, 55.2% (range, 20.0%-84.6%) were told to return in 3 years as recommended, 25.4% (range, 3.8%-56.6%) in 5 or more years, and 18.6% (range, 0%-47.2%) in less than 3 years.ConclusionAlthough overall screening quality was good, it varied considerably. Ongoing monitoring to identify performance problems is essential for all colorectal cancer screening activities, so that efforts designed to improve performance can be targeted to individual clinicians.