Reducing cancer disparities: Incident cancer after colonoscopies by primary care

减少癌症差异：初级保健结肠镜检查后的癌症发生率

• 批准号: 8035811
• 负责人: Sudha Xirasagar
• 金额: $ 31.91万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-06 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8035811
• 关键词: Accounting; Address; Adverse event; Advisory Committees; African American; Age; Algorithms; Ambulatory Surgical Procedures; American; Anatomy; Benchmarking; Biopsy; Cancer Detection; Categories; Cessation of life; Clinical; Clinical Protocols; Clinical effectiveness; Colonoscopes; Colonoscopy; Colorectal Cancer; Data; Detection; Educational Status; Endoscopy; Ensure; Excision; Funding; Gastroenterologist; Gastroenterology; Gold; High Prevalence; Incidence; Inferior; Intubation; Knowledge; Left; Lesion; Licensing; Literature; Location; Malignant Neoplasms; Masks; Measures; Medical; Metric; Minority; Modeling; Neoplasms; Normal tissue morphology; Patient Education; Patients; Performance; Persons; Physicians; Pilot Projects; Policies; Polyps; Population; Premalignant; Primary Care Physician; Primary Health Care; Procedures; Protocols documentation; Randomized Clinical Trials; Registries; Relative (related person); Research; Risk; Screening procedure; Side; Societies; Source; South Carolina; Specialist; Structure; Testing; Time; Training; Vital Statistics; Withdrawal; adenoma; cancer health disparity; cohort; colorectal cancer prevention; comparison group; design; evidence base; follow-up; high risk; innovation; men; neoplasm registry; patient safety; programs; quality assurance; scale up; skills; tumor

DESCRIPTION (provided by applicant): This project explores a key knowledge gap regarding the quality and colorectal cancer (CRC) protection effect of primary care physician (PCP)-performed colonoscopies under a innovative program in South Carolina that trains and utilizes primary care physicians (PCP) for colonoscopy screening. The program uses a unique clinical protocol, with inbuilt quality safeguards to compensate for PCPs' lack of formal gastroenterology training. A previous NCI-funded study documented the high quality and patient safety of PCP-performed colonoscopies, providing the evidence base for the clinical effectiveness of PCP-colonoscopies performed in a structured setting. The same study also found significantly higher colonoscopy rates among patients of trained AA PCPs relative to untrained PCPs, an increase that was led by drastic increases among AAs, particularly AA men. Though promising, questions remain to be addressed before this innovative program can be scaled up to expand colonoscopy access for AAs. The questions are: a) Do PCPs' adenoma/cancer yield rates and procedure performance indicators match those of specialists performing colonoscopies in the same clinical setting and screening patients drawn from the same population? This study aim will clarify the performance quality of PCP-colonoscopies accounting for potential confounding due to unobserved population-related variables. b) Do PCPs confer similar CRC protection rates as specialists serving the same population, and do PCP-cohort protection rates compare well with the CRC protection rates found in randomized clinical trials? This study will investigate these questions using data on 13,688 screening colonoscopies by 54 PCPs and on 5031 colonoscopies by 5 specialists. To detect differences in performance quality and case yield rates we will compare PCP-performed procedures with specialist-performed procedures on the following metrics: a) polyp detection rate and mean polyps detected per patient, b) adenoma detection rate and mean adenomas per patient, c) advanced adenoma detection rate and mean per patient, d) cancer detection rate, e) location of detected adenomas - right-sided, left-sided and cecal adenomas, f) colonoscope insertion and withdrawal times when no polyp was found and when polyp(s) were found, g) cecal intubation rate, h) reasons for incomplete colonoscopies (not achieving cecal intubation), i) repeat colonoscopy due to unsatisfactory procedure, and j) all of the above indicators classified by PCPs' training status and procedure volume. To satisfy study aim 2 we will assess the number and type of incident cancers among PCP- vs. specialist-served cohorts (65,685 person years (PYO) from 13,688 PCP colonoscopies, and 34,255 PYOs from the 5031 specialist-performed colonoscopies). We will source cancer data from the South Carolina Central Cancer Registry (SCCCR) and death data from the SC Vital Statistics registry. We will classify incident cancers by probable cause as per the documented algorithm (Pabby et al) into 4 categories: missed cancer, new cancer, incomplete removal, failed biopsy detection, and incomplete colonoscopy. PUBLIC HEALTH RELEVANCE: This project explores a key knowledge gap regarding the performance quality and colorectal cancer (CRC) protection effect of colonoscopies performed by primary care physicians (PCP) under a innovative program (with inbuilt quality assurance mechanisms to compensate for PCPs' lack of formal gastroenterology training) in South Carolina. The study will explore: a) whether the PCP-colonoscopy cohort rates of precancerous adenomas and cancer, and other quality measures are comparable to those of the specialist cohort performed in the same clinical setting and population, and b) whether PCP-performed colonoscopies confer similar CRC protection on patients as specialists, and as per the documented rates in randomized clinical trials. It will use colonoscopy and cancer registry data pertaining to 65,685 person years (PYO) of follow-up following 13,688 PCP colonoscopies, and 34,255 PYOs following 5031 specialist-performed colonoscopies.

描述（由申请人提供）：该项目探讨了一个关键的知识差距，关于初级保健医生（PCP）进行结肠镜检查的质量和结直肠癌（CRC）的保护作用，根据南卡罗来纳州的一个创新计划，培训和利用初级保健医生（PCP）进行结肠镜检查筛查。该计划采用独特的临床方案，内置质量保障措施，以弥补PCP缺乏正式的胃肠病学培训。先前由NCI资助的研究记录了PCP进行的结肠镜检查的高质量和患者安全性，为在结构化环境中进行的PCP结肠镜检查的临床有效性提供了证据基础。同一项研究还发现，受过训练的AA PCP患者的结肠镜检查率显著高于未经训练的PCP，这一增加是由于AA，特别是AA男性的急剧增加。尽管前景看好，但在扩大这一创新计划以扩大AA的结肠镜检查范围之前，仍有一些问题有待解决。这些问题是：a）PCP的腺瘤/癌症发生率和手术性能指标是否与在相同临床环境中进行结肠镜检查和筛选来自相同人群的患者的专家相匹配？本研究的目的是阐明PCP结肠镜检查的性能质量，解释由于未观察到的人群相关变量导致的潜在混淆。B）PCP是否提供与服务于同一人群的专家相似的CRC保护率，PCP队列保护率与随机临床试验中发现的CRC保护率相比是否良好？ 本研究将使用54名PCP进行的13，688次筛查结肠镜检查和5名专家进行的5031次结肠镜检查的数据来调查这些问题。为了检测性能质量和病例产出率的差异，我们将在以下指标上比较PCP执行的手术与专科医生执行的手术：a）息肉检测率和每例患者检测到的平均息肉，B）腺瘤检测率和每例患者的平均腺瘤，c）晚期腺瘤检测率和每例患者的平均值，d）癌症检测率，e）检测到的腺瘤的位置-右侧，左侧和盲肠腺瘤，f）未发现息肉和发现息肉时的结肠镜插入和撤出时间，g）盲肠插管率，h）不完整结肠镜检查的原因（未实现盲肠插管），i）由于不满意的程序而重复结肠镜检查，以及j）根据PCP的培训状态和程序量分类的所有上述指标。为了满足研究目标2，我们将评估PCP与专科医生服务队列中的癌症发病数量和类型（来自13，688例PCP结肠镜检查的65，685人年（PYO）和来自5031例专科医生进行的结肠镜检查的34，255人年）。我们将从南卡罗来纳州中央癌症登记处（SCCCR）获取癌症数据，并从SC生命统计登记处获取死亡数据。我们将根据记录的算法（Pabby等人）按可能原因将偶发癌症分为4类：漏诊癌症、新发癌症、不完全切除、活检检测失败和不完全结肠镜检查。 公共卫生相关性：本项目探讨了南卡罗来纳州初级保健医生（PCP）在创新计划（内置质量保证机制，以弥补PCP缺乏正规胃肠病学培训）下进行结肠镜检查的性能质量和结直肠癌（CRC）保护效果方面的关键知识差距。该研究将探讨：a）PCP结肠镜检查队列的癌前腺瘤和癌症的发生率以及其他质量指标是否与在相同临床环境和人群中进行的专家队列的发生率相当，以及B）PCP进行的结肠镜检查是否为患者提供与专家相似的CRC保护，以及根据随机临床试验中记录的发生率。它将使用结肠镜检查和癌症登记数据，这些数据涉及13，688次PCP结肠镜检查后的65，685人年（PYO）随访，以及5031次专科医生进行的结肠镜检查后的34，255人年（PYO）随访。

项目成果

Authors' response to Eluri et al. letter to the editor regarding: Colorectal cancer prevention by an optimized colonoscopy protocol in routine practice.

作者对 Eluri 等人的回应。

• DOI: 10.1002/ijc.29472
• 发表时间: 2015
• 期刊: International journal of cancer
• 影响因子: 6.4
• 作者: Xirasagar,Sudha;deGroen,PietC
• 通讯作者: deGroen,PietC

Colonoscopy screening among US adults aged 40 or older with a family history of colorectal cancer.

• DOI: 10.5888/pcd12.140533
• 发表时间: 2015-05-21
• 期刊: Preventing chronic disease
• 影响因子: 5.5
• 作者: Tsai MH;Xirasagar S;Li YJ;de Groen PC
• 通讯作者: de Groen PC

Colorectal cancer prevention by a CLEAR principles-based colonoscopy protocol: an observational study.

通过基于 CLEAR 原则的结肠镜检查方案预防结直肠癌：一项观察性研究。

• DOI: 10.1016/j.gie.2019.11.043
• 发表时间: 2020
• 期刊: Gastrointestinal endoscopy
• 影响因子: 7.7
• 作者: Xirasagar,Sudha;Wu,Yuqi;Tsai,Meng-Han;Zhang,Jiajia;Chiodini,Stephanie;deGroen,PietC
• 通讯作者: deGroen,PietC

Diagnostic and Demographic Differences Between Incarcerated and Nonincarcerated Youth (Ages 6-15) With ADHD in South Carolina.

南卡罗来纳州被监禁和非监禁青少年（6-15 岁）患有多动症的诊断和人口统计差异。

• DOI: 10.1177/1087054713506746
• 发表时间: 2017
• 期刊: Journal of attention disorders
• 影响因子: 3
• 作者: Soltis,SamuelL;Probst,Janice;Xirasagar,Sudha;Martin,AmyB;Smith,BradleyH
• 通讯作者: Smith,BradleyH