Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system
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Abstract
Purpose
Appropriate surveillance intervals for colorectal cancer (CRC) screening is one of the Centers for Medicare and Medicaid Services 2014 physician quality reporting system measures. Appropriateness of surveillance intervals will continue to be monitored closely, particularly as reimbursements become tied to quality measures.
Aims
Quantify and identify predictors for guideline-concordant surveillance recommendations after adenoma polypectomy.
Methods
We conducted a retrospective cohort study of patients who had colonoscopy with polypectomy at a safety-net health system between June 2011 and December 2013. Surveillance recommendations shorter and longer than guideline recommendations were defined as potential overuse and underuse. We used multivariate logistic regression to identify correlates of guideline-concordant surveillance recommendations, overuse, and underuse.
Results
Among 1,822 patients with polypectomy, 1,329 had ≥1 adenoma. Surveillance interval recommendations were guideline-concordant in 1,410 (77.4 %) patients, potential overuse in 263 (14.4 %), potential underuse in 85 (4.7 %), and missing in 64 (3.5 %) patients. Predictors of guideline-concordant recommendations in multivariate analyses included age >65 years (OR 1.36, 95 % CI 1.02–1.80), incomplete resection (OR 3.58, 95 % CI 1.41–9.09), and good/excellent prep quality (OR 2.22, 95 % CI 1.72–2.86). Underuse recommendations were more likely in patients with ≥3 adenomas; overuse recommendations were more likely in patients with high-grade dysplasia or fair prep quality and less likely in those with piecemeal resection, ≥3 adenomas, age >65, or Hispanic ethnicity.
Conclusions
Surveillance recommendations are not concordant with guidelines in one of four cases. Interventions to improve prep quality and guideline concordance of surveillance recommendations can improve cost-effectiveness of CRC screening.
Keywords
Colon cancer Screening Prep quality Colonoscopy Surveillance Colorectal adenomasNotes
Acknowledgments
This study was conducted as part of the NCI-funded consortium Population-Based Research Optimizing Screening through Personalized Regiments (PROSPR) with support from NIH/NCI Grant U54CA163308-01. Dr. Halm was supported in part by the AHRQ Center for Patient-Centered Outcomes Research (R24 HS022418). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or AHRQ.
Author contributions
Ben Kahn and Zachary Freeland involved in acquisition, analysis, and interpretation of data, and drafted the manuscript. Purva Gopal, Deepak Agrawal, Christian Mayorga, and Rozina Mithani interpreted data and critically revised the manuscript for intellectual content. Celette Skinner and Ethan Halm interpreted data, critical revision of the manuscript for intellectual content, and funding. Amit G. Singal studied the concept and design, analyzed and interpreted the data, drafted the manuscript, critically revised the manuscript for intellectual content, responsible for study supervision, and is the guarantor of the article.
Compliance with ethical standards
Conflicts of interest
None of the authors have any conflicts of interest to declare.
Supplementary material
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