Variations in Colonoscopy Screening: A Population Based Study

描述(申请人提供)：结肠镜检查提供了检测和切除息肉的机会，因此可以防止结直肠癌(CRC)的发展。结肠镜检查并不是一种无限的资源。它的适当利用对优化CRC筛查至关重要。结肠镜检查的实践和结果存在很大的差异。了解这些差异以及导致最有效和最高效结果的因素将有助于在社区和学术环境中进行适当的结直肠癌筛查。通过这一创新项目，我们将通过扩展新罕布夏州结肠镜检查注册表，将结肠镜检查结果与患者因素和病理结果联系起来，将结肠镜检查结果与患者因素和病理结果联系起来，从而表征新汉普郡(NH)成人人群的结肠镜检查实践、结果及其变化。这一特征将是动态的，涉及当前的做法以及做法如何随着时间的推移而演变，包括CT结肠成像和粪便DNA分析等新兴技术的影响。随着研究结果的增加，我们将与关键的利益相关者一起探索它们的影响，从而更好地了解并促进未来的质量改进和研究项目，以改进提供结肠镜检查以控制结直肠癌。这项工作受到过去十年基于人口的乳房X光检查登记工作的启发和启发。其中之一，NH乳房摄影网络，将为该项目提供经过验证的方法、实践经验和生产力记录。NH乳房摄影登记处的首席调查员和工作人员在结肠镜检查的这项新工作中发挥了积极和实质性的作用。项目目标包括：目标1：确定息肉切除率、息肉摘除类型、病理结果、完成率和筛查、监测和诊断性结肠镜检查的并发症，包括使用基于州的结肠镜检查登记调整患者风险因素。目的2：检查结肠镜医师对重复检查时间的建议与针对特定患者亚组的公认指南之间的差异。目标3：确定目标1和目标2中确定的变异来源，包括患者、结肠镜检查人员和实践环境因素对改进的贡献和潜力的程度。目标4：与主要利益相关者(结肠镜医生、初级保健临床医生和社区成员)分享AIMS 1-3的发现，探讨他们对这些发现的影响的看法，并就可在后续提案中解决的干预机会提出见解。目的5：探讨在学术和社区环境中应用的新兴技术对结肠镜检查的影响。公共卫生相关性：结直肠癌是主要杀手，而结肠镜检查是目前我们最好的防御措施。受基于人群的乳房X光检查登记所取得的乳腺癌防治进展的启发和启发，该项目将创建一个结肠镜检查登记，以促进我们对结肠镜检查如何在具有代表性的社区和学术环境中提供，它目前取得的成果，以及这种做法如何随着技术进步而发展的理解。为了刺激创新，医生和社区利益相关者将参与解释发现并制定必要的行动，以提高其质量和适当的使用。

DESCRIPTION (provided by applicant): Colonoscopy affords the opportunity for detection and removal of polyps and thus can prevent the development of colorectal cancer (CRC). Colonoscopy is not an unlimited resource. Its appropriate utilization is critical to optimizing CRC screening. Wide variations exist in colonoscopy practice and outcomes. Understanding these variations and the factors contributing to the most effective and efficient outcomes would inform appropriate CRC screening in both community and academic settings. Through this innovative project we will characterize colonoscopy practices, outcomes and their variations for the New Hampshire (NH) adult population by expanding the NH Colonoscopy Registry to include a high proportion of NH colonoscopists, linking colonoscopy findings with patient factors and pathology results. This characterization will be dynamic, addressing current practices and how practices evolve over time including the impact of emerging technologies such as CT colonography and fecal DNA analysis. As findings accrue, we will explore their implications with key stakeholders leading to better understanding and to future quality improvement and research projects that improve the provision of colonoscopy to control CRC. This work is informed and inspired by work of population-based mammography registries over the past decade. One of these, the NH Mammography Network, will provide proven methods, practical experience, and a record of productivity to this project. The NH Mammography Registry principal investigator and staff play active and substantial roles in this new work on colonoscopy. Project aims include: AIM 1: To identify polypectomy rates, types of polypectomies, pathology findings, completion rates, and complications for screening, surveillance, and diagnostic colonoscopy, including adjustment for patient risk factors, using a state-based colonoscopy registry. AIM 2: To examine discrepancies between colonoscopists' recommendations for timing of repeat exams and recognized guidelines for specific patient subgroups. AIM 3: To identify sources of variation identified in Aim 1 and Aim 2, including the degree to which patient, colonoscopist, and practice setting factors contribute and have the potential for modification. AIM 4: To share findings from Aims 1-3 with key stakeholders (colonoscopists, primary care clinicians, and community members), explore their views on the implications of these findings, and develop insights on opportunities for intervention that could be addressed in subsequent proposals. AIM 5: To explore the impact of emerging technologies on colonoscopy as applied in both academic and community-settings. PUBLIC HEALTH RELEVANCE: Colorectal cancer is a major killer and colonoscopy is currently our best defense. Inspired and informed by the progress against breast cancer that has resulted from population- based mammography registries, this project will create a colonoscopy registry to advance our understanding of how it is provided in representative community and academic settings, the outcomes it currently achieves, and how the practice evolves as technology advances. To spur innovations, physician and community stakeholders will be engaged in interpreting the findings and developing actions needed to increase its quality and appropriate use.