Variations in Colonoscopy Screening: A Population Based Study

结肠镜检查的差异：一项基于人群的研究

• 批准号: 7913924
• 负责人: Lynn F Butterly
• 金额: $ 84.37万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7913924
• 关键词: Academia; Accounting; Address; Adoption; Adult; Advisory Committees; Ambulatory Surgical Procedures; American; American Cancer Society; Area; Basic Science; Breast Cancer Detection; Breast Cancer Early Detection; Breast Cancer Surveillance Consortium; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Colonoscopy; Colorectal Cancer; Communities; Community Physician; Community Practice; Computed Tomographic Colonography; Consensus; CpCp; DNA analysis; Data; Data Collection; Data Set; Data Sources; Databases; Detection; Development; Diagnostic; Early Diagnosis; Effectiveness; Emerging Technologies; Evaluation; Excision; Fecal occult blood; Fostering; Foundations; Future; Gastrointestinal Endoscopy; Geographic Locations; Guidelines; Healthcare; Healthcare Systems; Incidence; Individual; Intervention; Link; Malignant Neoplasms; Mammography; Manuscripts; Methodology; Methods; Modification; Morbidity - disease rate; National Cancer Institute; Natural History; Nature; New Hampshire; Outcome; Pathology; Pathway interactions; Patients; Pattern; Performance; Play; Polypectomy; Polyps; Population; Population Characteristics; Preventive; Primary Health Care; Principal Investigator; Procedures; Productivity; Publishing; Randomized Controlled Trials; Recommendation; Registries; Research; Research Personnel; Research Project Grants; Research Technics; Resources; Risk; Risk Factors; Role; Screening procedure; Series; Services; Site; Societies; Source; Staging; Subgroup; Technology; Testing; Time; Uncertainty; Update; Variant; Work; abstracting; base; cancer prevention; clinical practice; colorectal cancer prevention; colorectal cancer screening; community setting; cost; evidence base; experience; fight against; follow-up; improved; innovation; insight; malignant breast neoplasm; mammography registry; member; mortality; population based; prevent; rural area; weapons

ABSTRACT: 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. PROJECT NARRATIVE: 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.

摘要： 结肠镜检查提供了检测和切除息肉的机会，因此可以预防结肠炎。 结直肠癌（CRC）的发展。结肠镜检查不是一个无限的资源。其合理利用是 对优化CRC筛查至关重要。结肠镜检查实践和结果存在很大差异。 了解这些差异以及有助于实现最有效和最高效结果的因素， 在社区和学术环境中为适当的CRC筛查提供信息。 通过这个创新的项目，我们将描述结肠镜检查的做法，结果和他们的特点。 通过扩大新罕布什尔州结肠镜登记研究以纳入新罕布什尔州（NH）成人人群的变化 高比例的NH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。 这种定性将是动态的，涉及当前的实践以及实践如何随时间演变 包括CT结肠成像和粪便DNA分析等新兴技术的影响。作为调查结果 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 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基于人群的乳腺X线摄影登记工作 十年其中之一，NH乳房X线摄影网络，将提供行之有效的方法，实践经验， 这个项目的生产力记录。NH乳房X光检查注册中心的主要研究者和工作人员 在结肠镜检查的新工作中发挥了积极和实质性的作用。项目目标包括： 目的1：确定息肉切除率、息肉切除术类型、病理学发现、完成率， 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，使用基于州的结肠镜登记。 目的2：检查结肠镜医师建议的重复检查时间之间的差异 以及针对特定患者亚组的公认指南。 目的3：确定目的1和目的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有助于并具有修改的潜力。 目标4：与关键利益相关者（结肠镜检查师、初级保健临床医生和 社区成员），探讨他们对这些发现的影响的看法，并制定 关于干预机会的见解，可在随后的提案中加以处理。 目的5：探讨新兴技术对结肠镜检查的影响， 社区设置。项目叙述： 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。 受人口增长带来的乳腺癌防治进展的启发和启发- 基于乳腺X线摄影登记，该项目将创建结肠镜登记，以推进我们的 了解它是如何提供在代表性的社区和学术环境， 它目前取得的成果，以及随着技术的进步，实践如何演变。以刺激 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。