Addressing Colonoscopy Quality to Increase Capacity for Colorectal Cancer Screening (CCSG YR13)

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Colorectal cancer (CRC) is the third most diagnosed cancer in the United States. Routine CRC screening is recommended for individuals ages 45 and older, but is only effective when completed appropriately, like completing diagnostic colonoscopy after a fecal immunochemical test (FIT). Effectiveness is further impacted by colonoscopy quality. In 2007, a standardized colonoscopy reporting and data system (CO-RADS) was developed using the key indicators for continuous quality improvement identified by the Multi-Society Task Force on Colorectal Cancer (MSTF-CRC). Based on the literature, some variability in the quality of colonoscopy provided in clinical practice is expected, but there is an urgent need to standardize colorectal early detection screening services, particularly as we consider how best to address colonoscopy capacity issues in underserved settings. Our long-term goal is to ensure the quality of colonoscopies in communities where capacity may be limited. Our overall objective is to determine what resources for colorectal cancer screening are available and the quality of service by a range of provider specialties and types. Our rationale for the proposed research is e to improve the effectiveness of colonoscopies in CRC screenings by impacting cecal intubation rates, adenoma detection rates, mean withdrawal time, and adequate bowel preps. We plan to accomplish our overall objective for this project through the following three specific aims: 1. Identify the challenges for colonoscopy completion in rural geography. The emphasis in this aim is gaining the knowledge about service availability and patient need from a population perspective. 2. Examine providers’ alignment with guideline recommendations for screening and frequency. The study focus of this aim is the variability in screening performance based on provider type. 3. Developing a new endoscopy training program for physicians completing a general surgery residency. The training program will address the major areas of improvement needed based on the findings from the previous aims. With respect to outcomes, we expect to identify the full complement of response elements which determine the overall quality of colorectal cancer screening services. Such results are expected to vertically advance the outcomes of screening interventions and maximize cost-effectiveness. Equally important, the results are expected to have a positive impact because it is probable this highly specific and sensitive training model will save resources that are currently strained.