Evaluation of an intervention to increase screening colonoscopy in an urban public hospital setting
Evaluation of an intervention to increase screening colonoscopy in an urban public hospital setting
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DOI：
10.1007/s11524-006-9029-6
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发表时间：
2006-03-01
影响因子：
6.6
通讯作者：
Schori, M
中科院分区：
文献类型：
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作者：
Nash, D;Azeez, S;Schori, M
根据最近的一项家庭调查，只有50%的50岁及以上的纽约人报告曾接受过任何形式的结直肠癌筛查。这项调查的目的是评估一项以医院为基础的干预措施的影响，该措施旨在消除林肯医疗中心（一家位于美国最贫困人口普查区之一的大型城市公立医院）及时进行结直肠癌筛查的卫生保健系统障碍。我们对11个月内进行的所有结肠镜检查进行了回顾性分析，在此期间进行了多管齐下的干预，以增加筛查结肠镜检查的数量。在研究期间雇用了两名“患者导航员”，为结肠镜检查患者提供连续性。还实施了直接内窥镜转诊系统。还对胃肠（GI）套件进行了改进，以提高运营效率。在引入患者导航器后，筛查和诊断性结肠镜检查的预约中断率立即出现了显著和持续的下降（从2003年5月的67%下降到2003年6月的5%）。在患者导航器干预后，保留结肠镜检查预约的可能性增加了近3倍（相对风险=2.6，95% CI 2.2-3.0）。结肠镜检查筛查率从每月56.8例增加到每月119例。该设施在周围邮政编码为50岁及以上的人群中提供的筛查结肠镜检查覆盖率从5.2%增加到15.6%（RR 3.0，95% CI 1.9-4.7）。努力增加筛查结肠镜检查的数量是非常成功的，这在很大程度上是由于患者导航员的影响，简化的转诊系统和GI套件的增强。这些研究结果表明，有显着的卫生保健系统的障碍，结肠镜检查，当解决，可能会有显着的影响，在一般人群中的筛查结肠镜检查率。
Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two "patient navigators" were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk=2.6, 95% CI 2.2-3.0). The rate of screening colonoscopies increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged SO and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9-4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population.