Understanding recommendations for screening colonoscopy intervals

描述（由申请人提供）：尽管指南建议结肠镜筛查间隔为10年，但高达60%的结肠镜检查正常的平均风险患者被建议在< 10年内再次进行结肠镜筛查。过度使用筛查结肠镜检查浪费了数十亿美元，并降低了结肠镜检查的适当使用能力。了解医生建议缩短间隔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，建立自我报告的推荐实践是合理准确的，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推荐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医疗记录中记录的建议。为了实现这些具体目标，本研究将与临床结果研究倡议（CORI）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、24个州的大学。美国国立卫生研究院（NIH）资助了CORI联盟，为研究和质量改进提供内窥镜检查登记。参与的医生使用CORI电子内窥镜报告程序生成临床使用的结肠镜报告，然后报告以电子方式发送到国家内窥镜数据库（NED）的中央数据存储库。本研究将使用NED获得医生对重复结肠镜筛查的建议。NED的初步数据（2009-2011）表明，315名CORI医生进行了超过15,000次正常结肠镜检查，以进行平均风险筛查。对于第一个目标，将对所有进行过正常结肠镜检查进行平均风险筛查的CORI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结肠镜筛查间隔中的作用。预计样本至少为120名医生。第二个目的是将问卷测量的自我报告推荐行为与NED中记录的推荐行为进行比较。我们最终将利用这项研究产生的信息来制定一种干预措施，以防止结肠镜检查的过度使用。

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.