Variations in Colonoscopy Screening: A Population Based Study

描述（由申请人提供）：结肠镜检查提供了检测和切除息肉的机会，因此可以预防结直肠癌（CRC）的发展。结肠镜检查不是一个无限的资源。它的适当利用对于优化CRC筛查至关重要。结肠镜检查实践和结果存在很大差异。了解这些变化和因素有助于最有效和最高效的结果将告知适当的CRC筛查在社区和学术环境。通过这一创新项目，我们将通过扩大新罕布什尔州结肠镜登记处以包括高比例的新罕布什尔州结肠镜医师，将结肠镜检查结果与患者因素和病理结果联系起来，来表征新罕布什尔州（NH）成人人群的结肠镜检查实践、结果及其变化。这种表征将是动态的，涉及当前的实践以及实践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。随着研究结果的积累，我们将与主要利益相关者探讨其影响，以更好地理解和未来的质量改进和研究项目，改善结肠镜检查的提供，以控制CRC。这项工作的信息和灵感来自于过去十年中基于人群的乳腺X射线摄影登记处的工作。其中之一，NH乳腺X线摄影网络，将提供行之有效的方法，实践经验，并记录生产力的这个项目。NH乳腺X线摄影登记处的主要研究者和工作人员在这项结肠镜检查的新工作中发挥着积极和实质性的作用。项目目标包括：目标1：通过一项基于州的结肠镜登记研究，确定息肉切除率、息肉切除类型、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，包括调整患者风险因素。目标2：检查结肠镜医师对复查时间的建议与特定患者亚组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、结肠镜医师和实践设置因素的影响程度以及修改的可能性。目标4：与关键利益相关者（结肠镜医生、初级保健临床医生和社区成员）分享目标1-3的发现，探讨他们对这些发现的影响的看法，并就后续提案中可能涉及的干预机会提出见解。目的5：探讨新兴技术在学术和社区环境中应用对结肠镜检查的影响。公共卫生相关性：结直肠癌是一个主要的杀手，结肠镜检查是目前我们最好的防御。受基于人群的乳腺X线摄影登记研究所取得的乳腺癌防治进展的启发和信息，该项目将创建一个结肠镜登记研究，以促进我们对结肠镜检查在代表性社区和学术环境中的提供方式、目前取得的成果以及随着技术进步实践如何演变的理解。为了促进创新，医生和社区利益相关者将参与解释调查结果，并制定提高其质量和适当使用所需的行动。

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.