Addressing Colonoscopy Quality to Increase Capacity for Colorectal Cancer Screening (CCSG YR13)

结直肠癌(CRC)是美国诊断人数第三多的癌症。建议进行常规的CRC筛查 适用于45岁及以上的个人，但只有在适当完成时才有效，如完成诊断 粪便免疫化学试验(FIT)后的结肠镜检查。疗效进一步受到结肠镜检查质量的影响。2007年，一个 标准化结肠镜报告和数据系统(CO-RADS)使用持续的关键指标开发 多社会结直肠癌特别工作组(MSTF-CRC)确定的质量改进。基于 文献中，在临床实践中提供的结肠镜检查的质量有一定的可变性，但有一个迫切的问题 需要标准化结直肠早期检测筛查服务，特别是在我们考虑如何最好地解决 服务不足环境中的结肠镜检查能力问题。 我们的长期目标是确保能力可能有限的社区的结肠镜检查质量。我们的整体 目标是确定可用于结直肠癌筛查的资源和服务质量 提供商专业和类型的范围。我们建议进行这项研究的理据是为了提高 结肠镜检查在结直肠癌筛查中对盲肠插管率、腺瘤发现率、平均撤退时间、 和充足的肠道准备。 我们计划通过以下三个具体目标来实现这个项目的总体目标： 1.确定在农村地区完成结肠镜检查面临的挑战。这一目标的重点是获得 从人口的角度了解服务可获得性和患者需求。 2.检查提供者与筛查和频率指南建议的一致性。这项研究 这一目标的重点是基于提供者类型的筛查业绩的可变性。 3.为完成普通外科实习的医生制定新的内窥镜培训计划。这个 培训计划将根据调查结果解决需要改进的主要领域 以前的目标。 关于结果，我们期望确定决定总体结果的全部应对要素。 结直肠癌筛查服务的质量。预计这样的结果将垂直推进筛查结果 干预措施，最大限度地提高成本效益。同样重要的是，预计结果将产生积极影响 因为这种高度具体和敏感的培训模式很可能会节省目前紧张的资源。

Colorectal cancer (CRC) is the third most diagnosed cancer in the United States. Routine CRC screening is recommended for individuals ages 45 and older, but is only effective when completed appropriately, like completing diagnostic colonoscopy after a fecal immunochemical test (FIT). Effectiveness is further impacted by colonoscopy quality. In 2007, a standardized colonoscopy reporting and data system (CO-RADS) was developed using the key indicators for continuous quality improvement identified by the Multi-Society Task Force on Colorectal Cancer (MSTF-CRC). Based on the literature, some variability in the quality of colonoscopy provided in clinical practice is expected, but there is an urgent need to standardize colorectal early detection screening services, particularly as we consider how best to address colonoscopy capacity issues in underserved settings. Our long-term goal is to ensure the quality of colonoscopies in communities where capacity may be limited. Our overall objective is to determine what resources for colorectal cancer screening are available and the quality of service by a range of provider specialties and types. Our rationale for the proposed research is e to improve the effectiveness of colonoscopies in CRC screenings by impacting cecal intubation rates, adenoma detection rates, mean withdrawal time, and adequate bowel preps. We plan to accomplish our overall objective for this project through the following three specific aims: 1. Identify the challenges for colonoscopy completion in rural geography. The emphasis in this aim is gaining the knowledge about service availability and patient need from a population perspective. 2. Examine providers’ alignment with guideline recommendations for screening and frequency. The study focus of this aim is the variability in screening performance based on provider type. 3. Developing a new endoscopy training program for physicians completing a general surgery residency. The training program will address the major areas of improvement needed based on the findings from the previous aims. With respect to outcomes, we expect to identify the full complement of response elements which determine the overall quality of colorectal cancer screening services. Such results are expected to vertically advance the outcomes of screening interventions and maximize cost-effectiveness. Equally important, the results are expected to have a positive impact because it is probable this highly specific and sensitive training model will save resources that are currently strained.