Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon.
Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
J Rural Health. 2018 Feb;34 Suppl 1(Suppl 1):s75-s83. doi: 10.1111/jrh.12231. Epub 2017 Jan 3.
Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings.
The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites.
No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106).
ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.
结直肠癌筛查是有效的。要在 2018 年前使 80%以上的 50 岁以上人群完成筛查，就需要在全国范围内（包括农村地区）具备充足的结肠镜检查能力，而农村地区的结肠镜检查提供者可能接受的专业培训较少。我们的目的是研究农村地区结肠镜检查的质量。
临床结果研究倡议（CORI）和俄勒冈农村实践为基础的研究网络（ORPRN）合作，招募俄勒冈州农村诊所向 CORI 的国家内镜数据库（NED）提交结肠镜检查报告。2009 年 1 月至 2011 年 10 月期间，将 10 个 ORPRN 站点与非 ORPRN 农村（n=11）和非农村（n=43）站点进行比较。对所有站点计算了已建立的结肠镜检查质量指标。
与非农村医生相比，没有 ORPRN 医生是胃肠病学家。ORPRN 实践中，87.4%的检查到达盲肠，而农村站点为 89.3%（P=0.0002），非农村站点为 90.9%（P<0.0001）。ORPRN 实践中切除的息肉更有可能未被取出（84.7%对 91.6%；P<0.0001）和送到病理科（77.1%对 91.3%；P<0.0001）。ORPRN 实践与非农村实践的总体息肉检出率（39.0%对 40.3%）相似（P=0.217）。在有息肉的检查中，ORPRN 站点的最大息肉直径在 6-9mm 的比例为 20.8%，而非农村站点为 26.8%（P<0.0001），而直径>9mm 的息肉为 16.6%对 18.7%（P=0.106）。
ORPRN 站点在大多数结肠镜检查质量指标上表现良好，表明高质量的结肠镜检查可以在农村地区进行。
