John Jaison, Al-Douri Abdul, Candelaria Bretta, Gandhi Saurin, Guzik Paul, Herndon Brent, Kim Christopher, Kluz Nicole, Thompson Jennifer, Trevino Jessica, Valencia Victoria, Pignone Michael
Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Gastroenterol Res Pract. 2020 Oct 31;2020:6240687. doi: 10.1155/2020/6240687. eCollection 2020.
Delivery of high-quality colonoscopy and adherence to evidence-based surveillance guidelines is essential to a high-quality screening program, especially in safety net systems with limited resources. We sought to assess colonoscopy quality and ensure appropriate surveillance in a network of safety net practices.
We identified age-eligible patients ages 50-75 within a Federally Qualified Health Center (FQHC) clinic system with evidence of colonoscopy in preceding 10 years. We performed chart reviews to assess key aspects of colonoscopy quality: bowel preparation quality, evidence of cecal intubation, cecal withdrawal time, and the adenoma detection rate. We then utilized established guidelines to assess and revise surveillance colonoscopy intervals, determine whether appropriate surveillance had taken place, and schedule overdue patients as appropriate.
Of 26,394 age-eligible patients, a total of 3,970 patients had evidence of prior colonoscopy and 1,709 charts were selected and reviewed. Mean age was 57, 54% identified as women and 51% identified as Hispanic. Of 1709 colonoscopies reviewed, 77% had data on bowel preparation, and of those, 85% had adequate preparation quality. Cecal intubation was documented in 89% of procedures. Adequate cecal withdrawal time was documented in 59% of those with documented cecal intubation. Overall adenoma detection rate was 42%. Initial surveillance interval was clearly stated in 72% ( = 1238) of procedures. Of these, initial recommended intervals were too short in 24.5% ( = 304) and too long in 3.6% ( = 45). A total of 132 patients (10.7%) were overdue for appropriate surveillance and were referred for follow-up colonoscopy.
Overall, the quality of screening colonoscopy was high, but reporting was incomplete. We found fair adherence to evidence-based surveillance guidelines, with significant opportunities to extend surveillance intervals and improve adherence to best practices.
提供高质量的结肠镜检查并遵循循证监测指南对于高质量的筛查项目至关重要，尤其是在资源有限的安全网系统中。我们试图评估安全网医疗机构网络中的结肠镜检查质量，并确保进行适当的监测。
我们在联邦合格健康中心（FQHC）诊所系统中确定了年龄在50至75岁之间且在过去10年内有结肠镜检查证据的符合年龄条件的患者。我们进行病历审查以评估结肠镜检查质量的关键方面：肠道准备质量、盲肠插管证据、盲肠退出时间和腺瘤检出率。然后，我们利用既定指南评估和修订监测结肠镜检查间隔，确定是否进行了适当的监测，并酌情安排逾期患者进行检查。
在26394名符合年龄条件的患者中，共有3970名患者有先前结肠镜检查的证据，选取并审查了1709份病历。平均年龄为57岁，54%为女性，51%为西班牙裔。在审查的1709例结肠镜检查中，77%有肠道准备数据，其中85%的肠道准备质量良好。89%的操作记录了盲肠插管情况。在记录了盲肠插管的患者中，59%的患者盲肠退出时间足够。总体腺瘤检出率为42%。72%（n = 1238）的操作明确说明了初始监测间隔。其中，初始推荐间隔过短的占24.5%（n = 304），过长的占3.6%（n = 45）。共有132名患者（10.7%）逾期未进行适当监测，被转诊进行后续结肠镜检查。
总体而言，筛查结肠镜检查质量较高，但报告不完整。我们发现对循证监测指南的遵循情况尚可，有很大机会延长监测间隔并提高对最佳实践的遵循程度。
