Adherence to Guideline-Appropriate Recommendations After Normal CRC Screening Colonoscopy in Average-Risk Individuals
After a normal CRC screening colonoscopy in an average-risk individual, guidelines recommend repeat colonoscopy in 10 years. This is a priority colonoscopy quality indicator per multi-society position statements with target of 90% adherence. If bowel preparation is inadequate, current CRC screening guidelines also recommend repeat colonoscopy in < 1 yr. As part of a multi-center, 4-phase quality improvement project, we assessed adherence to these guideline recommendations for the 2018 calendar year at our institution.
Inclusion criteria: In order to minimize possible confounders, patients were limited to: (a) average-risk, 50-75 year olds; (b) colonoscopy performed in 2018; (c) sole indication-CRC screening; (d) no biopsy, polypectomy, or any abnormal findings on procedure report. Study setting: Single tertiary care academic medical center with “open” endoscopy unit used by private practice gastroenterologists (GIs), colorectal surgeons, and academic GIs. Co-Primary Endpoints: frequency of recommending 10-yr interval or no further CRC screening colonoscopy for complete procedure with adequate bowel preparation or recommending < 1 yr interval if inadequate bowel preparation. Secondary endpoints: frequency of guideline-appropriate recommendation in academic GI vs private practice GI vs colorectal surgeons by chi-square analysis. Patient data is de-identified and collected as part of QI initiative, so IRB waiver was granted.
In 2018, 1073 normal CRC screening colonoscopies meeting inclusion criteria were performed by 39 different endoscopists: mean patient age-59.5 y/o (± 8.1 yrs); 55.8% female; race-69.5% white, 19.5%-African American, 4.4%-Asian. No documentation of bowel prep in 9.6%. Overall, 77.5% (832/1073) had guideline-appropriate recommendation. Surgeons used guideline appropriate recommendations more frequently than academic GIs or private practice GIs: 81.2% (496/611) vs 74.4% (328/441) vs 38.1% (8/21), p < 0.001. Guideline appropriate recommendations were more common for complete colonoscopy with adequate prep vs procedures with documented inadequate prep: 81.9% vs 55.5%, respectively, p < 0.001.
Adherence to guideline recommendations did not meet target of 90% adherence, was lower for GI endoscopists vs surgeons, and was particularly low if incomplete colonoscopy due to poor prep at our institution. These findings justify need for QI intervention, which is currently being developed to improve adherence.
Aneese A, Edhi A, Imam Z, Schoenfeld P. S304 Adherence to Guideline-Appropriate Recommendations After Normal CRC Screening Colonoscopy in Average-Risk Individuals. American Journal of Gastroenterology. 2021 Oct 1;116:S133.