Marcus R Johnson1, Janet Grubber2, Steven C Grambow3, Matthew L Maciejewski4, Tyra Dunn-Thomas2, Dawn Provenzale5, Deborah A Fisher6. 1. Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina. 2. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina. 3. Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina. 4. Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina. 5. Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina. 6. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: Deborah.Fisher@Duke.edu.
Abstract
BACKGROUND & AIMS: Colonoscopy can decrease colorectal cancer (CRC) mortality, although performing this procedure more frequently than recommended could increase costs and risks to patients. We aimed to determine rates and correlates of physician non-adherence to guidelines for repeat colonoscopy screening and polyp surveillance intervals. METHODS: We performed a multi-center, retrospective, observational study using administrative claims, physician databases, and electronic medical records (EMR) from 1455 patients (50-64 y old) who underwent colonoscopy in the Veterans Affairs healthcare system in fiscal year 2008. Patients had no prior diagnosis of CRC or inflammatory bowel disease, and had not undergone colonoscopy examinations in the previous 10 years. We compared EMR-documented, endoscopist-recommended intervals for colonoscopies with intervals recommended by the 2008 Multi-Society Task Force guidelines. RESULTS: The overall rate of non-adherence to guideline recommendations was 36% and ranged from 3% to 80% among facilities. Non-adherence was 28% for patients who underwent normal colonoscopies, but 45%-52% after colonoscopies that identified hyperplastic or adenomatous polyps. Most of all recommendations that were not followed recommended a shorter surveillance interval. In adjusted analyses, non-adherence was significantly higher for patients whose colonoscopies identified hyperplastic (odds ratio [OR] = 3.1; 95% CI, 1.7-5.5) or high-risk adenomatous polyps (OR = 3.0; 95% CI, 1.2-8.0), compared to patients with normal colonoscopy examinations, but not for patients with low-risk adenomatous polyps (OR = 1.8; 95% CI, 0.9-3.7). Nonadherence was also associated with bowel preparation quality, geographic region, Charlson comorbidity score, and colonoscopy indication. CONCLUSIONS: In a managed care setting with salaried physicians, endoscopists recommend repeat colonoscopy sooner than guidelines for more than one third of patients. Factors associated with non-adherence to guideline recommendations were colonoscopy findings, quality of bowel preparation, and geographic region. Targeting endoscopist about non-adherence to colonoscopy guidelines could reduce overuse of colonoscopy and associated healthcare costs.
BACKGROUND & AIMS: Colonoscopy can decrease colorectal cancer (CRC) mortality, although performing this procedure more frequently than recommended could increase costs and risks to patients. We aimed to determine rates and correlates of physician non-adherence to guidelines for repeat colonoscopy screening and polyp surveillance intervals. METHODS: We performed a multi-center, retrospective, observational study using administrative claims, physician databases, and electronic medical records (EMR) from 1455 patients (50-64 y old) who underwent colonoscopy in the Veterans Affairs healthcare system in fiscal year 2008. Patients had no prior diagnosis of CRC or inflammatory bowel disease, and had not undergone colonoscopy examinations in the previous 10 years. We compared EMR-documented, endoscopist-recommended intervals for colonoscopies with intervals recommended by the 2008 Multi-Society Task Force guidelines. RESULTS: The overall rate of non-adherence to guideline recommendations was 36% and ranged from 3% to 80% among facilities. Non-adherence was 28% for patients who underwent normal colonoscopies, but 45%-52% after colonoscopies that identified hyperplastic or adenomatous polyps. Most of all recommendations that were not followed recommended a shorter surveillance interval. In adjusted analyses, non-adherence was significantly higher for patients whose colonoscopies identified hyperplastic (odds ratio [OR] = 3.1; 95% CI, 1.7-5.5) or high-risk adenomatous polyps (OR = 3.0; 95% CI, 1.2-8.0), compared to patients with normal colonoscopy examinations, but not for patients with low-risk adenomatous polyps (OR = 1.8; 95% CI, 0.9-3.7). Nonadherence was also associated with bowel preparation quality, geographic region, Charlson comorbidity score, and colonoscopy indication. CONCLUSIONS: In a managed care setting with salaried physicians, endoscopists recommend repeat colonoscopy sooner than guidelines for more than one third of patients. Factors associated with non-adherence to guideline recommendations were colonoscopy findings, quality of bowel preparation, and geographic region. Targeting endoscopist about non-adherence to colonoscopy guidelines could reduce overuse of colonoscopy and associated healthcare costs.
Authors: Bryan C Batch; Karen Goldstein; William S Yancy; Linda L Sanders; Susanne Danus; Steven C Grambow; Hayden B Bosworth Journal: J Womens Health (Larchmt) Date: 2017-07-21 Impact factor: 2.681
Authors: Joseph C Anderson; John A Baron; Dennis J Ahnen; Elizabeth L Barry; Roberd M Bostick; Carol A Burke; Robert S Bresalier; Timothy R Church; Bernard F Cole; Marcia Cruz-Correa; Adam S Kim; Leila A Mott; Robert S Sandler; Douglas J Robertson Journal: Gastroenterology Date: 2017-02-20 Impact factor: 22.682
Authors: Melissa Magrath; Edward Yang; Chul Ahn; Christian A Mayorga; Purva Gopal; Caitlin C Murphy; Samir Gupta; Deepak Agrawal; Ethan A Halm; Eric K Borton; Celette Sugg Skinner; Amit G Singal Journal: J Natl Compr Canc Netw Date: 2018-11 Impact factor: 11.908
Authors: Roxanne Wadia; Mark Shifman; Forrest L Levin; Luis Marenco; Cynthia A Brandt; Kei-Hoi Cheung; Tamar Taddei; Michael Krauthammer Journal: AMIA Jt Summits Transl Sci Proc Date: 2017-07-26
Authors: Caitlin C Murphy; Robert S Sandler; Janet M Grubber; Marcus R Johnson; Deborah A Fisher Journal: Clin Gastroenterol Hepatol Date: 2015-10-19 Impact factor: 11.382