Colonoscopy in Rural Oregon Practice (CROP)

描述（由申请人提供）：美国预防服务工作组建议所有50岁及以上的成年人进行结直肠癌筛查，结肠镜检查越来越多地被用作主要筛查方法。进行结肠镜检查的能力可能会超出需求，特别是在没有胃肠道专家的农村社区。初步数据显示，俄勒冈州农村医院85%的内窥镜检查是筛查结肠镜检查，这些结肠镜检查主要由全科医生进行。人们对农村初级保健机构结肠镜检查的使用和质量知之甚少。本提案旨在记录俄勒冈州农村地区结肠镜筛查和诊断的质量。CORI（临床结果研究倡议）在28个州建立了一个由86个成人胃肠道诊所组成的联盟，这些诊所使用计算机化的内窥镜手术报告生成器来创建结肠镜检查报告。该软件将用于测量俄勒冈州24个农村地区进行结肠镜检查的10个质量指标。具体目标1：我们将组建农村结肠镜检查联盟，并在俄勒冈州的24个农村站点安装CORI软件，收集常规实践数据。具体目标2：我们将比较俄勒冈州农村地区结肠镜检查的表现与国家CORI联盟和基于证据的检查质量指标标准。10项质量指标包括盲肠插管率、结肠镜下停药时间、肠道准备、息肉切除术率、意外事件发生率和随访建议的记录。我们俄勒冈州农村实践联盟的这些指标的结果将与国家内窥镜数据库的结果进行比较，该数据库主要由城市实践中经验丰富的胃肠病学家汇编。这也将使农村社区实践与结肠镜检查的表现进行比较，主要是由全科医生进行的，而不是由胃肠病学家进行的。摘要：努力提高结直肠癌筛查率需要提高目前进行结肠镜检查的能力。评估农村地区和非胃肠病学家结肠镜检查的实践绩效质量，将为确定这是否是一项可行的提高结肠镜检查能力的国家战略提供重要指导。提高结直肠癌筛查率的努力需要提高目前进行结肠镜检查的能力。评估农村地区和非胃肠病学家结肠镜检查的实践绩效质量，将为确定这是否是一项可行的提高结肠镜检查能力的国家战略提供重要指导。

DESCRIPTION (provided by applicant): The US Preventive Services Task Force recommends that all adults age 50 and older be screened for colorectal cancer with colonoscopy increasingly being utilized as the primary screening method. Capacity to perform colonoscopy may exceed demand, particularly in rural communities who do not have GI specialists. Preliminary data shows that 85% of endoscopy procedures in rural Oregon hospitals are screening colonoscopies and that these colonoscopies are predominantly performed by generalist physicians. Little is known about the utilization and quality of colonoscopy in rural primary care settings. This proposal is designed to document the quality of screening and diagnostic colonoscopies occurring in rural Oregon. CORI (Clinical Outcomes Research Initiative) has created a consortium of 86 adult GI practice sites in 28 states which use a computerized endoscopic procedure report generator to create colonoscopy reports. This software will be used to measure 10 quality indicators in 24 rural Oregon practices performing screening colonoscopy. Specific aim 1: We will form a rural colonoscopy consortium and install the CORI software in 24 rural sites in Oregon to collect routine practice data. Specific aim 2: We will compare the performance of colonoscopy in rural Oregon to the national CORI consortium and to evidence-based standards on indicators of exam quality. Among the 10 quality indicators are cecal intubation rate, colonoscope withdrawal time, bowel preparation, polypectomy rates, rates of unplanned events, and documentation of follow-up recommendations. Results of these indicators in our rural Oregon practice consortium will be compared to those results in the National Endoscopic Database, which is largely compiled of experienced gastroenterologists in urban practice. This will also allow comparison of rural community practice with performance of colonoscopy principally by generalist physicians as compared to that performed by gastroenterologists. Summary: Efforts to improve colorectal cancer screening rates require increasing the current capacity to perform colonoscopy. Evaluating practice performance quality of colonoscopy in rural areas and by non-gastroenterologists will provide important guidance in determining whether this is a feasible national strategy for increasing colonoscopic capacity.Project Narrative Efforts to improve colorectal cancer screening rates require increasing the current capacity to perform colonoscopy. Evaluating practice performance quality of colonoscopy in rural areas and by non-gastroenterologists will provide important guidance in determining whether this is a feasible national strategy for increasing colonoscopic capacity.