Department of Medicine, Division of Digestive and Liver Diseases, Mailman School of Public Health, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA.
J Clin Gastroenterol. 2011 May-Jun;45(5):e47-53. doi: 10.1097/MCG.0b013e3181f595c3.
To increase colorectal cancer screening among urban minorities, New York Presbyterian Hospital/Columbia University, with support from the New York City Department of Health and the Citywide Colon Cancer Control Coalition (C5), instituted a patient navigation and direct endoscopic referral system. We assessed the effect of this program on the volume of colonoscopy in this institution, which caters to a socioeconomically diverse patient population.
We compared colonoscopy volume during the first year of the navigator program with the volume during the year before this program. We stratified on Medicaid status to assess the secular trend of screening rates. To assess quality during this period, we measured cecal intubation rates, preparation quality, and adenoma detection rates.
Of the 749 patients assessed by the patient navigators, 678 (91%) underwent colonoscopy. Colonoscopy volume among the Medicaid outpatients increased by 56% (957 to 1489). Adenoma detection was 27% and the cecal intubation rate was 97%. Comparing navigated patients with the nonnavigated Medicaid outpatients, preparation quality was superior (34% vs. 40% suboptimal, P=0.0282), although preparation quality remained inferior to that of private patients (20% suboptimal, P<0.0001).
Volume of the colonoscopy increased, coinciding with the onset of the patient navigation program. This increase was nearly entirely owing to a rise in the colonoscopies among Medicaid outpatients, the principal focus of the navigator program. This increase in quantity was accomplished while maintaining an overall high level of quality as measured by cecal intubation rates and adenoma detection, although preparation quality requires further efforts at improvement.
为了提高城市少数民族的结直肠癌筛查率，纽约长老会医院/哥伦比亚大学在纽约市卫生局和全市结肠癌控制联盟（C5）的支持下，建立了一个患者导航和直接内镜转诊系统。我们评估了该计划对本机构结肠镜检查量的影响，本机构服务的患者人群具有社会经济多样性。
我们比较了导航员计划实施的第一年与该计划实施前一年的结肠镜检查量。我们按医疗补助状况进行分层，以评估筛查率的趋势。为了评估这段时间的质量，我们测量了盲肠插管率、准备质量和腺瘤检出率。
在 749 名接受患者导航员评估的患者中，有 678 名（91%）接受了结肠镜检查。医疗补助门诊患者的结肠镜检查量增加了 56%（从 957 例增加到 1489 例）。腺瘤检出率为 27%，盲肠插管率为 97%。与未接受导航的医疗补助门诊患者相比，接受导航的患者准备质量更好（34%vs.40%准备不充分，P=0.0282），尽管准备质量仍低于私人患者（20%准备不充分，P<0.0001）。
结肠镜检查量增加，与患者导航计划的开始时间相符。这一增长主要归因于医疗补助门诊患者结肠镜检查量的增加，这是导航员计划的主要重点。在保持盲肠插管率和腺瘤检出率等整体高质量的情况下，增加了结肠镜检查量，尽管准备质量仍需进一步改进。
