Understanding recommendations for screening colonoscopy intervals

描述（由申请人提供）：尽管指南建议10年间隔进行结肠镜检查，但高达60%的结肠镜检查正常的平均风险患者建议在< 10年内返回进行重复结肠镜检查。过度使用结肠镜检查浪费了数十亿美元，并降低了结肠镜检查的能力。了解医生建议缩短间隔时间的原因对于设计成功的干预措施以防止过度使用至关重要。此外，确定自我报告的推荐做法是合理准确的，将有助于未来对过度使用的调查。本研究的具体目的是：1）确定在平均风险患者中建议重复筛查结肠镜检查的决定因素; 2）直接比较医生自我报告的筛查建议与病历中记录的建议。为了实现这些具体目的，本研究将与临床结局研究倡议（科里）合作进行，该倡议包括70个实践地点。（医院，门诊护理中心，私人诊所，大学）在24个州。美国国立卫生研究院（NIH）资助了科里协会，为研究和质量改进提供内窥镜登记。参与医师使用科里电子内镜报告程序生成结肠镜检查报告供临床使用，然后将报告以电子方式发送到国家内镜数据库（NED）的中央数据库。本研究将使用NED获得医生对重复筛查结肠镜检查的建议。初步NED数据（2009-2011）表明，315名科里医生进行了超过15，000例正常结肠镜检查，用于平均风险筛查。对于第一个目标，将对所有进行过正常结肠镜检查以进行平均风险筛查的科里医生进行先前开发和试点测试的调查。评估知识、态度、主观规范和外部因素在医生推荐的结肠镜检查时间间隔中的作用。预计样本至少为120名医生。对于第二个目标，将比较通过问卷测量的自我报告的推荐行为和NED中记录的推荐。我们最终将利用这项研究产生的信息来开发一种干预措施，以防止结肠镜过度使用。

DESCRIPTION (provided by applicant): Although guidelines recommend a 10-year interval for screening colonoscopy, up to 60% of average-risk patients with a normal colonoscopy are recommended to return for repeat screening colonoscopy in < 10 years. Overuse of screening colonoscopy wastes billions of dollars and reduces colonoscopy capacity for appropriate use. Understanding the reasons why physicians recommend shorter intervals is critical to designing successful interventions to prevent overuse. In addition, establishing that self-reported recommendation practices are reasonably accurate will facilitate future investigations of overuse. The specific aims of this study are 1) to identify the determinants of recommendations for repeat screening colonoscopy among average risk patients and 2) to directly compare physician self-reported screening recommendations to recommendations documented in medical records To accomplish these specific aims, the study will be conducted in collaboration with the Clinical Outcomes Research Initiative (CORI), which includes 70 practice sites (hospitals, ambulatory care centers, private practices, universities) in 24 states. The National Institutes of Health (NIH) has funded the CORI consortium to provide an endoscopy registry for research and quality improvement. Participating physicians use the CORI electronic endoscopy report program to generate the colonoscopy report for clinical use, and then the reports are electronically sent to a central data repository in the National Endoscopic Database (NED). This study will use the NED to obtain physician recommendations for repeat screening colonoscopy. Preliminary NED data (2009-2011) indicate that over 15,000 normal colonoscopies were performed for average risk screening by 315 CORI physicians. For the first aim, a previously developed and pilot-tested survey will be administered to all CORI physicians who have performed a normal colonoscopy for average risk screening. to assess the role of knowledge, attitudes, subjective norms, and external factors in physician recommendations for screening colonoscopy intervals. The expected sample is at least 120 physicians. For the second aim, self-reported recommendation behavior measured by the questionnaire and the recommendation as documented in the NED will be compared. We will ultimately use the information generated by this study to develop an intervention to prevent colonoscopy overuse.