Colonoscopy in Rural Oregon Practice (CROP)

俄勒冈州农村结肠镜检查实践 (CROP)

• 批准号: 7546620
• 负责人: DAVID A LIEBERMAN
• 金额: $ 13.86万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-12-26 至 2010-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7546620
• 关键词: Adult; Advisory Committees; Age; American; Benchmarking; Cancer Etiology; Cessation of life; Clinical; Collection; Colonoscopes; Colonoscopy; Colorectal Cancer; Communities; Community Practice; Computer software; Data; Data Collection; Databases; Diagnosis; Diagnostic; Documentation; Effectiveness; Endoscopy; Ensure; Event; Excision; Fecal occult blood; Flexible fiberoptic sigmoidoscopy; Gastroenterologist; Gastroenterology; General Practitioners; Goals; Guidelines; Healthcare; Healthy People 2010; Hospitals; Image; Individual; Intestines; Intubation; Lead; Measures; Methods; Modality; Oregon; Outcome; Outcomes Research; Pathology; Patients; Performance; Physicians; Polypectomy; Population; Preparation; Preventive; Primary Health Care; Procedures; Quality Indicator; Recommendation; Reporting; Risk; Rural; Rural Community; Rural Health; Screening procedure; Services; Sigmoidoscopy; Site; Societies; Specialist; Surgeon; Testing; Time; Withdrawal; aged; college; colorectal cancer screening; computerized; design; evidence base; experience; follow-up; health care quality; improved; lower GI series; mortality; neoplastic; practice-based research network; primary care setting; routine practice; rural area; software development

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.

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肠直肠癌筛查，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超过需求，特别是在没有GI专家的农村社区。初步数据显示，俄勒冈州农村医院85%的内镜检查程序是筛查结肠镜检查，这些结肠镜检查主要由全科医生进行。关于结肠镜检查在农村初级保健机构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筛查和诊断性结肠镜检查的质量。科里（临床结果研究倡议）在28个州建立了一个由86个成人GI实践站点组成的联盟，这些站点使用计算机化内窥镜程序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个农村进行筛查结肠镜检查的实践中的10个质量指标。具体目标1：我们将组建一个农村结肠镜检查联盟，并在俄勒冈州的24个农村站点安装科里软件，以收集常规实践数据。具体目标2：我们将比较俄勒冈州农村地区结肠镜检查与国家科里联盟和基于证据的检查质量指标标准的性能。10个质量指标包括盲肠插管率、结肠镜撤出时间、肠道准备、息肉切除率、计划外事件发生率和随访建议记录。这些指标在我们的农村俄勒冈州实践联盟的结果将比较那些结果在国家内窥镜数据库，这主要是在城市实践中有经验的胃肠病学家汇编。这也将使农村社区的做法与结肠镜检查的性能主要是由全科医生相比，由胃肠病学家进行比较。总结：提高结直肠癌筛查率的努力需要增加目前进行结肠镜检查的能力。在农村地区和非胃肠病学家的结肠镜检查的实践性能质量评估将提供重要的指导，以确定这是否是一个可行的国家战略，增加结肠镜capability.Project叙述努力提高结直肠癌筛查率需要增加目前的能力进行结肠镜检查。评价农村地区和非胃肠病学家结肠镜检查的实践性能质量将提供重要的指导，以确定这是否是一个可行的国家战略，以增加结肠镜检查的能力。