Colorectal cancer (CRC) screening can reduce CRC incidence and mortality.1 Although CRC screening can be performed using stool-based methods or colonoscopy, many US providers prefer colonoscopy because it is both diagnostic and therapeutic, permitting simultaneous removal of precancerous lesions.2,3
Surveillance colonoscopy is required after polypectomy given an elevated risk of recurrent polyps and cancer.4,5 The long-term effectiveness of colonoscopy-based screening depends on appropriate surveillance intervals; however, previous studies suggest there is substantial overuse and underuse.6–8 Underuse may increase risk of interval cancer and cancer-related mortality,9,10 whereas overuse is associated with unnecessary costs and an increased risk of potential harms.5,11–14 Appropriate surveillance colonoscopy intervals, a focus of healthcare reform in gastroenterology, is one of the Centers for Medicare and Medicaid Services Physician Quality Reporting System measures.
A prior study at Parkland Health and Hospital System, the sole safety-net healthcare system for Dallas County, demonstrated guideline-adherent surveillance intervals in 77.4% of patients who underwent a polypectomy during colonoscopy.15 Recommendations representing potential overuse, underuse, and missing surveillance recommendations were observed in 14.4%, 4.7%, and 3.5% of patients, respectively. To address this, we developed and implemented an electronic medical record (EMR)–based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS) in December 2013. CoRS is a user-friendly, EMR-based template that captures data from colonoscopy and pathology reports and uses a computerized algorithm to generate tailored, guideline-adherent recommendations for the next surveillance colonoscopy after polypectomy.16 The CoRS algorithm is based on published guidelines and produces tailored reporting letters (in English and Spanish) for patients and their referring physicians. Provider acceptance and use in clinical practice exceeded 90% during the first 6 months after implementation. However, prior studies have shown that early provider acceptance of new interventions can decrease over time.16 Further, the impact of CoRS on guideline adherence to surveillance recommendations was unknown.
The goals of our study were to (1) evaluate the impact of CoRS implementation on guideline adherence of surveillance recommendations, (2) identify additional factors associated with guideline-adherent surveillance recommendations among patients who underwent colonoscopy with polypectomy, and (3) identify factors associated with providers' use of CoRS at an academic safety-net health system.
Dr. Gupta has disclosed that he is a consultant for Boston Scientific. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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 (U54CA163308-01) and NIH/NCI (P30 CA142543). Research reported in this publication was also supported in part by the National Center for Advancing Translational Sciences of the NIH (UL1TR001105). 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 NIH or AHRQ.
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