在城市公立医院环境中评估一项增加结肠镜筛查的干预措施。
Evaluation of an intervention to increase screening colonoscopy in an urban public hospital setting.
作者信息
Nash Denis, Azeez Sulaiman, Vlahov David, Schori Melissa
机构信息
Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA.
出版信息
J Urban Health. 2006 Mar;83(2):231-43. doi: 10.1007/s11524-006-9029-6.
Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two "patient navigators" were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk = 2.6, 95% CI 2.2-3.0). The rate of screening colonoscopies increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9-4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population.
根据最近的一项家庭调查，在50岁及以上的纽约人中，只有50%的人报告曾通过任何方式接受过结直肠癌筛查。本调查的目的是评估一项以医院为基础的干预措施的影响，该干预措施旨在消除林肯医疗中心（位于美国最贫困人口普查区之一的一家大型城市公立医院）及时进行结直肠癌筛查的医疗系统障碍。我们对在11个月期间进行的所有结肠镜检查进行了回顾性分析，在此期间实施了一项多管齐下的干预措施以增加筛查结肠镜检查的数量。在研究期间雇佣了两名“患者导航员”，为结肠镜检查患者提供连续性服务。还实施了直接内镜转诊系统（DERS）。对胃肠（GI）检查室也进行了改进以提高运营效率。在引入患者导航员后，筛查和诊断性结肠镜检查的爽约率立即出现了显著且持续的下降（从2003年5月的67%降至2003年6月的5%）。在患者导航员干预后，进行结肠镜检查预约的可能性增加了近3倍（相对风险=2.6，95%置信区间2.2 - 3.0）。筛查结肠镜检查的比率从每月56.8例增加到每月119例。该机构在周边邮政编码区域50岁及以上人群中提供的筛查结肠镜检查覆盖率从5.2%提高到了15.6%（相对风险3.0，95%置信区间1.9 - 4.7）。增加筛查结肠镜检查数量的努力非常成功，这在很大程度上归功于患者导航员的影响、简化的转诊系统以及胃肠检查室的改进。这些发现表明，结肠镜检查存在重大的医疗系统障碍，一旦解决，可能会对普通人群的筛查结肠镜检查率产生重大影响。
Zotero 插件