J Natl Compr Canc Netw. 2018 Nov;16(11):1321-1328. doi: 10.6004/jnccn.2018.7050.
Surveillance colonoscopy is required in patients with polyps due to an elevated colorectal cancer (CRC) risk; however, studies suggest substantial overuse and underuse of surveillance colonoscopy. The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). We performed a retrospective cohort study of patients who underwent colonoscopy with polypectomy at a safety-net healthcare system before (n=1,822) and after (n=1,320) implementation of CoRS in December 2013. Recommendations were classified as guideline-adherent or nonadherent according to the US Multi-Society Task Force on CRC. We defined surveillance recommendations shorter and longer than guideline recommendations as potential overuse and underuse, respectively. We used multivariable generalized linear mixed models to identify correlates of guideline-adherent recommendations. The proportion of guideline-adherent surveillance recommendations was significantly higher post-CoRS than pre-CoRS (84.6% vs 77.4%; <.001), with fewer recommendations for potential overuse and underuse. In the post-CoRS period, CoRS was used for 89.8% of cases and, compared with cases for which it was not used, was associated with a higher proportion of guideline-adherent recommendations (87.0% vs 63.4%; RR, 1.34; 95% CI, 1.23-1.42). In multivariable analysis, surveillance recommendations were also more likely to be guideline-adherent in patients with adenomas but less likely among those with fair bowel preparation and those with family history of CRC. Of 203 nonadherent recommendations, 70.4% were considered potential overuse, 20.2% potential underuse, and 9.4% were not provided surveillance recommendations. An EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
监测结肠镜检查适用于结直肠癌（CRC）风险升高的患者；然而，研究表明，监测结肠镜检查存在大量过度使用和使用不足的情况。本研究的目的是描述在实施基于电子病历（EMR）的结肠镜检查病理报告和临床决策支持系统（CoRS）后，监测建议的指南遵循情况。我们对 2013 年 12 月在一个医疗保障系统中接受结肠镜检查和息肉切除术的患者进行了回顾性队列研究，这些患者在实施 CoRS 前（n=1822）和后（n=1320）分别分为两组。建议根据美国多学会 CRC 工作组分为符合或不符合指南。我们将短于或长于指南建议的监测建议分别定义为潜在过度使用和使用不足。我们使用多变量广义线性混合模型来确定符合指南建议的相关因素。与实施 CoRS 前相比，实施 CoRS 后符合指南的监测建议比例显著提高（84.6%比 77.4%；<0.001），潜在过度使用和使用不足的建议减少。在 CoRS 实施后，89.8%的病例使用了 CoRS，与未使用 CoRS 的病例相比，符合指南建议的比例更高（87.0%比 63.4%；RR，1.34；95%CI，1.23-1.42）。多变量分析显示，腺瘤患者的监测建议更有可能符合指南，而肠道准备情况一般和有 CRC 家族史的患者的监测建议更不可能符合指南。在 203 条不符合指南的建议中，70.4%被认为是潜在过度使用，20.2%是潜在使用不足，9.4%未提供监测建议。基于 EMR 的 CoRS 得到了广泛应用，显著提高了监测建议的指南遵循度。
