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Casas MA, Schlottmann F, Steinberg L, Bessa X, Serradesanferm A, Pozo A, Torres S, Castells A, Balaguer F, Grau J, Pereyra L, Pellisé M. A mobile app to improve adherence to colorectal cancer screening and post polypectomy surveillance guidelines. BMC Gastroenterol 2025; 25:203. [PMID: 40148816 PMCID: PMC11948656 DOI: 10.1186/s12876-025-03796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 03/18/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Despite significant advances in prevention and early detection, colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. Inadequate adherence and/or lack of knowledge of guidelines have shown to prevent adequate screening and surveillance recommendations and hinder effective screening programs. OBJECTIVE Evaluate the implementation and real-world impact of a mobile app designed to optimize CRC screening and surveillance in accordance to recently updated guidelines. METHODS A mobile app including ergonomic algorithms integrating all pertinent guideline information was created by a group of experts. Data were collected from Catalonia healthcare professionals using the app between February 2023 and May 2024. Users' characteristics, consultation types, and patient data were analyzed to assess app's implementation, usage patterns, and impact on CRC screening and surveillance outcomes. RESULTS A total of 12,481 consultations were recorded; 3,054 (24.4%) screening and 9,427 (75.6%) post-polypectomy surveillance consultations. The app was increasingly and repeatedly used by professionals during the study period (72% retention rate). Among screening consultations, 2,082 (68.2%) patients were classified as average risk, suggesting the use of fecal occult blood test (FOBT) instead of colonoscopy. Among surveillance consultations, the app advised deferring follow-up colonoscopies and using FOBT instead in 4,748 (50%) patients based on negative index colonoscopy or the presence of low-risk polyps. Standard surveillance with colonoscopy at 3 years was recommended for 3,224 (34.1%) patients and intensive surveillance, requiring a colonoscopy at 1 year, was indicated for 749 (7.9%) patients. CONCLUSIONS A CRC screening and surveillance mobile app showed remarkable acceptance and uptake among healthcare professionals. Proper implementation of updated guidelines aided by the use of the app could significantly reduce the number of unnecessary screening and post-polypectomy surveillance colonoscopies, as well as help identifying high risk patients who require intensive surveillance. CLINICAL TRIAL Not applicable.
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Affiliation(s)
- María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, Buenos Aires, C1118AAT, Argentina.
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, Buenos Aires, C1118AAT, Argentina
| | - Leandro Steinberg
- Department of Gastroenterology, Hospital Durand of Buenos Aires, Aires, Argentina
| | - Xavier Bessa
- Department of Gastroenterology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, España
| | - Anna Serradesanferm
- Department of Preventive Medicine and Epidemiology Service, Hospital Clínic of Barcelona, Catalunya, España
| | - Angels Pozo
- Department of Preventive Medicine and Epidemiology Service, Hospital Clínic of Barcelona, Catalunya, España
| | - Sonia Torres
- Department of Gastroenterology, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, España
| | - Antoni Castells
- Department of Gastroenterology, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, España
- Facultat de Medicina i Ciències de la Salud, Universitat de Barcelona (UB), Barcelona, España
| | - Francesc Balaguer
- Department of Gastroenterology, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, España
- Facultat de Medicina i Ciències de la Salud, Universitat de Barcelona (UB), Barcelona, España
| | - Jaume Grau
- Department of Preventive Medicine and Epidemiology Service, Hospital Clínic of Barcelona, Catalunya, España
| | - Lisandro Pereyra
- Department of Gastroenterology, Hospital Alemán of Buenos Aires, Aires, Argentina
| | - María Pellisé
- Department of Gastroenterology, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, España
- Facultat de Medicina i Ciències de la Salud, Universitat de Barcelona (UB), Barcelona, España
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Pereyra L, Schlottmann F, Steinberg L, Lasa J. Colorectal Cancer Prevention: Is Chat Generative Pretrained Transformer (Chat GPT) ready to Assist Physicians in Determining Appropriate Screening and Surveillance Recommendations? J Clin Gastroenterol 2024; 58:1022-1027. [PMID: 38319619 DOI: 10.1097/mcg.0000000000001979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations. BACKGROUND Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services. METHODS An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app. RESULTS The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001]. CONCLUSIONS Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.
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Affiliation(s)
- Lisandro Pereyra
- Department of Gastroenterology
- Endoscopy Unit, Department of Surgery
| | - Francisco Schlottmann
- Endoscopy Unit, Department of Surgery
- Department of Surgery, Hospital Alemán of Buenos Aires
| | - Leandro Steinberg
- Department of Gastroenterology, Fundacion Favaloro, Buenos Aires, Argentina
| | - Juan Lasa
- Department of Gastroenterology, CEMIC, Buenos Aires, Argentina
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Poyet C, Scherer TP, Kunz M, Wanner M, Korol D, Rizzi G, Kaufmann B, Rohrmann S, Hermanns T. Retrospective analysis of the uptake of active surveillance for low-risk prostate cancer in Zurich, Switzerland. Swiss Med Wkly 2023; 153:40103. [PMID: 37499067 DOI: 10.57187/smw.2023.40103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES Active surveillance for low-risk prostate cancer closely monitors patients conservatively instead of the pursuit of active treatment to reduce overtreatment of insignificant disease. Since 2009, active surveillance has been recommended as the primary management option in the European Association of Urology guidelines for low-risk disease. The present study aimed to investigate the use and uptake of active surveillance over 10 years in our certified prostate cancer centre (University Hospital of Zurich) compared with those derived from the cancer registry of the canton of Zurich, Switzerland. MATERIALS AND METHODS We retrospectively identified all men diagnosed with low-risk prostate cancer at our institution and from the cancer registry of the canton of Zurich from 2009 to 2018. The primary treatment of each patient was recorded. Descriptive statistics were used to analyze the use of different treatments in our centre. The results were compared with those derived from the cancer registry. RESULTS A total of 3393 men with low-risk prostate cancer were included in this study (University Hospital of Zurich: n = 262; cancer registry: n = 3131). In the University Hospital of Zurich and cancer registry cohorts, 146 (55.7%) and 502 (16%) men underwent active surveillance, respectively. The proportions of local treatment [115 (43.9%) vs 2220 (71%)] and androgen deprivation therapy [0 (0%) vs 43 (1.4%)] were distinctly lower in the University Hospital of Zurich cohort than in the cancer registry cohort. The uptake of active surveillance over the years was high in the University Hospital of Zurich cohort (35.4% in 2009 and 88.2% in 2018) but only marginal in the cancer registry cohort (12.2% in 2009 and 16.2% in 2018). CONCLUSION Despite clear guideline recommendations, active surveillance for low-risk prostate cancer is still widely underused. Our analysis showed that access to a certified interdisciplinary tumour board significantly increases the use of active surveillance.
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Affiliation(s)
- Cédric Poyet
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas Paul Scherer
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Mirjam Kunz
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
- Cancer registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, University of Zurich, Switzerland
| | - Miriam Wanner
- Cancer registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, University of Zurich, Switzerland
| | - Dimitri Korol
- Cancer registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, University of Zurich, Switzerland
| | - Gianluca Rizzi
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Basil Kaufmann
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Sabine Rohrmann
- Cancer registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, University of Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
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Dong J, Wang LF, Ardolino E, Feuerstein JD. Real-world compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer polypectomy surveillance guidelines: an observational study. Gastrointest Endosc 2023; 97:350-356.e3. [PMID: 35998689 DOI: 10.1016/j.gie.2022.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/16/2022] [Accepted: 08/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Overuse of screening colonoscopy increases cost and procedural adverse events, but inadequate surveillance can miss the development of colorectal cancer. We measured compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) polypectomy surveillance guidelines in clinical records and a survey. METHODS We performed a retrospective study comparing surveillance intervals for first-time average-risk colonoscopies with the 2020 USMSTF guidelines. Cases were analyzed from 3 intervals (March 2021 to May 2021, November 2021 to January 2022, and April 2022 to May 2022), collectively termed the postguideline period, and a baseline period from November 2019 to January 2020. Real-world compliance rates were compared with results of a survey conducted between November 2020 and February 2021. RESULTS Overall compliance was 48.9% among 532 colonoscopies, ranging from 8.3% for low-risk adenomas (LRAs), 88.3% for high-risk adenomas, 63.1% for sessile serrated polyps (SSPs), and 88.6% for hyperplastic polyps. Compliance for LRA increased from the baseline period (.8% vs 8.3%, P = .003), and 95.3% of nonadherent LRA cases followed the 2012 USMSTF guidelines. Compliance for LRAs was 18.6% among respondents who provided a compliant surveillance interval for LRAs in the survey. Noncompliance was associated with finishing training >10 years ago (odds ratio, 1.9; 95% confidence interval, 1.4-2.7) and performing over 800 colonoscopies annually (odds ratio, 2.0; 95% confidence interval, 1.5-2.6). CONCLUSIONS Adoption of the 2020 USMSTF surveillance guidelines remains low at 2 years. Further research into outcomes for patients with LRAs and SSPs may increase guideline adoption.
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Affiliation(s)
- Jeffrey Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda F Wang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Ardolino
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Social exchange in buyer-supplier relationships and innovation speed: the mediating and moderating role of information sharing and knowledge channels. JOURNAL OF KNOWLEDGE MANAGEMENT 2022. [DOI: 10.1108/jkm-04-2022-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study recognizes service as the majority contributor to global and US gross domestic product and the importance of innovation speed to service innovation. Generating innovative products and services at a faster rate generates advantages for business-to-business (B2B) service organizations in keeping up with and moving ahead of rivals. This study aims to introduce the concept of capacity for social exchange (CSE) in buyer–supplier relationships, which reflects the degree to which individuals possess competencies that enable the exchange of information, and this study also explores how CSE affects knowledge sharing and innovation speed within a supply chain organization.
Design/methodology/approach
The sampling frame of this research consisted of service businesses in the USA. The data were collected through Zoomerang, an online survey research firm where the B2B panel of Zoomerang formed the sampling frame. The data was collected from 264 B2B service sector executives.
Findings
The key findings are as follows: CSE facilitates knowledge sharing; knowledge sharing is positively related to innovation speed; and the relationship between CSE and innovation speed is fully mediated by knowledge sharing. Additional analysis reveals that knowledge channels which are designed as boundary-spanning strategies used to transfer and create knowledge between business units, directly increase – and positively moderate – the relationship between CSE and innovation speed.
Originality/value
This study addresses the gap in literature focused on micro-level influencers on innovation. This study sets out by presenting the concept of CSE, and this study addresses limitations in prior work by examining the research questions.
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Shafer LA, Restall G, Simms A, Lee E, Park J, Singh H. Clinician based decision tool to guide recommended interval between colonoscopies: development and evaluation pilot study. BMC Med Inform Decis Mak 2022; 22:136. [PMID: 35581662 PMCID: PMC9112638 DOI: 10.1186/s12911-022-01872-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Optimal intervals between repeat colonoscopies could improve patient outcomes and reduce costs. We evaluated: (a) concordance between clinician and guideline recommended colonoscopy screening intervals in Winnipeg, Manitoba, (b) clinician opinions about the utility of an electronic decision-making tool to aid in recommending screening intervals, and (c) the initial use of a decision-making smartphone/web-based application. Methods Clinician endoscopists and primary care providers participated in four focus groups (N = 22). We asked participating clinicians to evaluate up to 12 hypothetical scenarios and compared their recommended screening interval to those of North American guidelines. Fisher’s exact tests were used to assess differences in agreement with guidelines. We developed a decision-making tool and evaluated it via a pilot study with 6 endoscopists. Result 53% of clinicians made recommendations that agreed with guidelines in ≤ 50% of the hypothetical scenarios. Themes from focus groups included barriers to using a decision-making tool: extra time to use it, less confidence in the results of the tool over their own judgement, and having access to the information required by the tool (e.g., family history). Most were willing to try a tool if it was quick and easy to use. Endoscopists participating in the tool pilot study recommended screening intervals discordant with guidelines 35% of the time. When their recommendation differed from that of the tool, they usually endorsed their own over the guideline. Conclusions Endoscopists are overconfident and inconsistent with applying guidelines in their polyp surveillance interval recommendations. Use of a decision tool may improve knowledge and application of guidelines. A change in practice may require that the tool be coupled with continuing education about evidence for improved outcomes if guidelines are followed. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01872-z.
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Affiliation(s)
- Leigh Anne Shafer
- Section of Gastroenterology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gayle Restall
- Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alexandria Simms
- Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Eugene Lee
- Section of Gastroenterology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - Jason Park
- Section of Gastroenterology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
| | - Harminder Singh
- Section of Gastroenterology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada. .,Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,CancerCare Manitoba Research Institute, Winnipeg, MB, Canada.
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Oh CK, Aniwan S, Piyachaturawat P, Wong Z, Soe T, Luvsandagva B, Tran QT, Fauzi A, Byeon JS, Cho YS. Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey. Gut Liver 2021; 15:878-886. [PMID: 33790055 PMCID: PMC8593505 DOI: 10.5009/gnl20166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS As the number of colonoscopies and polypectomies performed continues to increase in many Asian countries, there is a great demand for surveillance colonoscopy. The aim of this study was to investigate the adherence to postpolypectomy surveillance guidelines among physicians in Asia. METHODS A survey study was performed in seven Asian countries. An email invitation with a link to the survey was sent to participants who were asked to complete the questionnaire consisting of eight clinical scenarios. RESULTS Of the 137 doctors invited, 123 (89.8%) provided valid responses. Approximately 50% of the participants adhered to the guidelines regardless of the risk of adenoma, except in the case of tubulovillous adenoma ≥10 mm combined with high-grade dysplasia, in which 35% of the participants adhered to the guidelines. The participants were stratified according to the number of colonoscopies performed: ≥20 colonoscopies per month (high volume group) and <20 colonoscopies per month (low volume group). Higher adherence to the postpolypectomy surveillance guidelines was evident in the high volume group (60%) than in the low volume group (25%). The reasons for nonadherence included concern of missed polyps (59%), the low cost of colonoscopy (26%), concern of incomplete resection (25%), and concern of medical liability (15%). CONCLUSIONS A discrepancy between clinical practice and surveillance guidelines among physicians in Asia was found. Physicians in the low volume group frequently did not adhere to the guidelines, suggesting a need for continuing education and appropriate control. Concerns regarding the quality of colonoscopy and complete polypectomy were the main reasons for nonadherence.
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Affiliation(s)
- Chang Kyo Oh
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Satimai Aniwan
- Deprtment of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Panida Piyachaturawat
- Deprtment of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Zhiqin Wong
- Gastroentorology Unit, Department of Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Thida Soe
- Department of Gastroenterology, University of Medicine 1 Yangon, Yangon, Myanmar
| | | | - Quang Trung Tran
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Achmad Fauzi
- Department of Internal Medicine, University of Indonesia, Kota Depok, Indonesia
| | - Jeong-Sik Byeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Pereyra L, Steinberg L, Criniti JM, Luna P, Escobar R, Bun M, Yantorno M, Esteves S, Gonzalez N, Hoffman P, Marcolongo M, Jury G, Topor J, Trelles F, Nazar C, Arantes VN. Usefulness of a mobile app to improve performance of specialists in responding correctly to CRC screening and surveillance clinical scenarios. Endosc Int Open 2021; 9:E1640-E1648. [PMID: 34790526 PMCID: PMC8589534 DOI: 10.1055/a-1544-4773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background and study aims The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance. Patients and methods This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines. Results A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34-1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01-1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46-2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice. Conclusions A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.
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Affiliation(s)
| | - Leandro Steinberg
- Gastroenterology Department, Fundación Favaloro, Buenos Aires, Argentina
| | - Juan M. Criniti
- Internal Medicine Department, Hospital Alemán, Buenos Aires, Argentina
| | - Pablo Luna
- Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Rafael Escobar
- Gastroenterology Department, Sanatorio Mendez, Buenos Aires, Argentina
| | | | - Martín Yantorno
- Gastroenterology Department, General San Martín, La Plata, Argentina
| | - Sebastian Esteves
- Gastroenterology and Endoscopy Department, Clínica Cmic, Neuquén, Argentina
| | - Nicolas Gonzalez
- Gastroenterology Department, Hospital Británico Montevideo, Uruguay
| | - Pablo Hoffman
- Gastroenterology Unit, Gedyt, Buenos Aires, Argentina
| | - Mariano Marcolongo
- Gastroenterology and Endoscopy Department, Hospital Italiano, Buenos Aires Argentina
| | - Gastón Jury
- Gastroenterology Unit, Centro de Estudios Digestivos, Mar Del Plata, Argentina
| | - Javier Topor
- Gastroenterology Department, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Félix Trelles
- Gastroenterology Department, Hospital Durand, Buenos Aires, Argentina
| | - Cristina Nazar
- Gastroenterology Department, Hospital Bonorino Udaondo, Buenos Aires, Argentina
| | - Vitor N. Arantes
- Endoscopy Unit, Clinics Hospital, Federal University of Minas Gerais, Brasil
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Peterson E, May FP, Kachikian O, Soroudi C, Naini B, Kang Y, Myint A, Guyant G, Elmore J, Bastani R, Maehara C, Hsu W. Automated identification and assignment of colonoscopy surveillance recommendations for individuals with colorectal polyps. Gastrointest Endosc 2021; 94:978-987. [PMID: 34087201 DOI: 10.1016/j.gie.2021.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/24/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Determining surveillance intervals for patients with colorectal polyps is critical but time-consuming and challenging to do reliably. We present the development and assessment of a pipeline that leverages natural language processing techniques to automatically extract and analyze relevant polyp findings from free-text colonoscopy and pathology reports. Using this information, we categorized individual patients into 6 postcolonoscopy surveillance intervals defined by the U.S. Multi-Society Task Force on Colorectal Cancer. METHODS Using a set of 546 randomly selected colonoscopy and pathology reports from 324 patients in a single health system, we used a combination of statistical classifiers and rule-based methods to extract polyp properties from each report type, associate properties with unique polyps, and classify a patient into 1 of 6 risk categories by integrating information from both report types. We then assessed the pipeline's performance by determining the positive predictive value (PPV), sensitivity, and F-score of the algorithm, compared with the determination of surveillance intervals by a gastroenterologist. RESULTS The pipeline was developed using 346 reports (224 colonoscopy and 122 pathology) from 224 patients and evaluated on an independent test set of 200 reports (100 colonoscopy and 100 pathology) from 100 patients. We achieved an average PPV, sensitivity, and F-score of .92, .95, and .93, respectively, across targeted entities for colonoscopy. Pathology extraction achieved a PPV, sensitivity, and F-score of .95, .97, and .96. The system achieved an overall accuracy of 92% in assigning the recommended interval for surveillance colonoscopy. CONCLUSIONS This study demonstrates the feasibility of using machine learning to automatically extract findings and classify patients to appropriate risk categories and corresponding surveillance intervals. Incorporating this system can facilitate proactive and timely follow-up after screening colonoscopy and enable real-time quality assessment of prevention programs and providers.
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Affiliation(s)
- Emma Peterson
- Department of Radiological Sciences, Data Integration, Architecture, and Analytics Group, University of California Los Angeles, Los Angeles, California, USA
| | - Folasade P May
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity and Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA; Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Odet Kachikian
- Department of Radiological Sciences, Data Integration, Architecture, and Analytics Group, University of California Los Angeles, Los Angeles, California, USA
| | - Camille Soroudi
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Bita Naini
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Yuna Kang
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Anthony Myint
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Gordon Guyant
- Department of Radiological Sciences, Data Integration, Architecture, and Analytics Group, University of California Los Angeles, Los Angeles, California, USA
| | - Joann Elmore
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Roshan Bastani
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity and Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Cleo Maehara
- Department of Radiological Sciences, Data Integration, Architecture, and Analytics Group, University of California Los Angeles, Los Angeles, California, USA
| | - William Hsu
- Department of Radiological Sciences, Data Integration, Architecture, and Analytics Group, University of California Los Angeles, Los Angeles, California, USA
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10
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Grossi E, Pace F. Guidelines for the Perplexed: How to Maximize Colonoscopy Efficiency During the COVID-19 Pandemic. Dig Dis Sci 2021; 66:2473-2474. [PMID: 33001345 PMCID: PMC7527293 DOI: 10.1007/s10620-020-06634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Enzo Grossi
- Villa Santa Maria Foundation, Tavernerio, Italy
| | - Fabio Pace
- Division of Gastroenterology, ASST Bergamo Est, Seriate, BG, Italy.
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11
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Kozarek R. Underutilization of societal guidelines: occasional or widespread? Endosc Int Open 2021; 9:E986-E988. [PMID: 34222617 PMCID: PMC8211483 DOI: 10.1055/a-1399-8891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Richard Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States
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12
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Xiao AH, Chang SY, Stevoff CG, Komanduri S, Pandolfino JE, Keswani RN. Adoption of Multi-society Guidelines Facilitates Value-Based Reduction in Screening and Surveillance Colonoscopy Volume During COVID-19 Pandemic. Dig Dis Sci 2021; 66:2578-2584. [PMID: 32803460 PMCID: PMC7429116 DOI: 10.1007/s10620-020-06539-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND COVID-19 has caused a backlog of endoscopic procedures; colonoscopy must now be prioritized to those who would benefit most. We determined the proportion of screening and surveillance colonoscopies appropriate for rescheduling to a future year through strict adoption of US Multi-Society Task Force (USMSTF) guidelines. METHODS We conducted a single-center observational study of patients scheduled for "open-access colonoscopy"-ordered by a primary care provider without being seen in gastroenterology clinic-over a 6-week period during the COVID-19 pandemic. Each chart was reviewed to appropriately assign a surveillance year per USMSTF guidelines including demographics, colonoscopy history and family history. When guidelines recommended a range of colonoscopy intervals, both a "conservative" and "liberal" guideline adherence were assessed. RESULTS We delayed 769 "open-access" screening or surveillance colonoscopies due to COVID-19. Between 14.8% (conservative) and 20.7% (liberal), colonoscopies were appropriate for rescheduling to a future year. Conversely, 415 (54.0%) patients were overdue for colonoscopy. Family history of CRC was associated with being scheduled too early for both screening (OR 3.9; CI 1.9-8.2) and surveillance colonoscopy (OR 2.6, CI 1.0-6.5). The most common reasons a colonoscopy was inappropriately scheduled this year were failure to use new surveillance colonoscopy intervals (28.9%), incorrectly applied family history guidelines (27.2%) and recommending early surveillance colonoscopy after recent normal colonoscopy (19.3%). CONCLUSION Up to one-fifth of patients scheduled for "open-access" colonoscopy can be rescheduled into a future year based on USMSTF guidelines. Rigorously applying guidelines could judiciously allocate colonoscopy resources as we recover from the COVID-19 pandemic.
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Affiliation(s)
| | - Stephen Y Chang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Digestive Health Center, Northwestern Medicine, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA
| | - Christian G Stevoff
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Digestive Health Center, Northwestern Medicine, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA
| | - Srinadh Komanduri
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Digestive Health Center, Northwestern Medicine, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA
| | - John E Pandolfino
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Digestive Health Center, Northwestern Medicine, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA
| | - Rajesh N Keswani
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Digestive Health Center, Northwestern Medicine, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA.
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13
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van der Meulen MP, Korfage IJ, van Heijningen EMB, de Koning HJ, van Leerdam ME, Dekker E, Lansdorp-Vogelaar I. Interpretation and adherence to the updated risk-stratified guideline for colonoscopy surveillance after polypectomy - a nationwide survey. Endosc Int Open 2020; 8:E1405-E1413. [PMID: 33015344 PMCID: PMC7508656 DOI: 10.1055/a-1190-3656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 04/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background and study aims Low adherence to the Dutch guideline for colonoscopy surveillance after polypectomy led to release of a new guideline in 2013. This new guideline was risk-stratified at a more detailed level than the previous one to achieve more efficient use of colonoscopy resources. This study assessed the feasibility of the risk-stratified guideline by evaluating correct interpretation of and adherence to this guideline. Methods Based on semi-structured interviews with 10 gastroenterologists, we developed an online survey to evaluate gastroenterologists' recommendations for surveillance in 15 example cases of patients with polyps. If recommended intervals differed from the new guideline, respondents were asked to indicate their motives for doing so. Results Ninety-one of 592 (15.4 %) invited gastroenterologists responded to at least one case, of whom 84 (14.2 %) completed the survey. Gastroenterologists gave a correct recommendation in a median of 10 of 15 cases and adherence per case ranged from 14 % to 95 % (median case 76 %). The two cases that addressed management of serrated polyps were least often answered correctly (14 % and 28 % correct answers). Discrepancies were mainly due to misinterpretation of the guideline with respect to serrated polyps (48 %) or misreading of the questions (30 %). Conclusions Median adherence to the updated colonoscopy surveillance guideline of 76 % seems reasonable, and is higher than adherence to the previous guideline (range: 22 %-80 %, median 59 %). This shows that detailed (more complex) risk stratification for designation of a surveillance interval is feasible. Adherence could potentially be improved by clarifying correct interpretation of serrated polyps.
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Affiliation(s)
| | - Ida J. Korfage
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Harry J. de Koning
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastroenterology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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14
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Trainees' knowledge and application of guideline recommendations for colorectal cancer screening and surveillance. Cancer Treat Res Commun 2019; 21:100153. [PMID: 31229916 DOI: 10.1016/j.ctarc.2019.100153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Data shows that practicing physicians don't recommend colorectal (CRC) screening and surveillance as suggested by guidelines. We assessed knowledge of CRC guidelines in medical trainees. METHODS A survey assessing confidence and knowledge of published CRC guidelines was emailed to program directors (PDs) of Accreditation Council of Graduate Medical Education approved training programs in the United States. PDs were requested to forward it to trainees. We analyzed trainees' knowledge by answers to clinical vignettes and identification of factors required by guidelines for screening and post polypectomy colonoscopy interval. We compared confidence and knowledge by specialty. RESULTS 586 trainees in internal medicine (159), family medicine and primary care (147), gastroenterology (114), general surgery (51), ob/gyn (78), urology (13), and colorectal surgery (13) responded. 97% reported following guidelines. 68% and 50% stated confidence recalling screening and surveillance guidelines, respectively. 16% and 8% correctly identified all factors and answered corresponding vignettes for screening and surveillance, respectively. Overall accuracy of screening ranged between 11-23% and was not different between specialties (p = 0.11) while significant differences were noted between specialties in surveillance knowledge (0-39%, p < 0.001). CONCLUSIONS United States trainees' CRC screening and surveillance knowledge is poor. Measures are needed to enhance knowledge of CRC guidelines.
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15
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Koh FH, Chan DKH, Ng J, Tan KK. Adherence to surveillance guidelines following colonic polypectomy is abysmal. J Gastrointest Oncol 2019; 10:166-170. [PMID: 31032081 PMCID: PMC6465487 DOI: 10.21037/jgo.2018.11.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/13/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Surveillance guidelines following excision of colonic tubular adenomas are well established. However, adherence to the guidelines are rarely audited. The aim of our study was to evaluate the rate of compliance to the recommended guidelines following polyp removal. METHODS A review of a prospectively collected colonoscopy database in a single tertiary institution was conducted for all patients who underwent polypectomy in 2008. We excluded patients who were diagnosed with or had prior history of colorectal malignancy. The frequency of subsequent colonoscopic were evaluated against the recommended guidelines based on the clinico-histological characteristics of the removed polyps. RESULTS There were 419 colonoscopies with polypectomies performed in 2008. The patient cohort had a median age of 60 years (range, 26-95 years), with the most common diagnosis being tubular adenoma with low grade dysplasia (n=291, 69.5%). Adherence to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) post-polypectomy surveillance guidelines, based on the factors such as the characteristics of the colonic polyps and bowel preparation at initial colonoscopy, was only 13.8% (n=58). There were 107 (25.5%) patients who had their surveillance endoscopy performed earlier than recommended. None of them were diagnosed with malignancy. The majority of patients (n=192, 45.8%), had surveillance scopes later than recommended or were lost to follow-up. Amongst these patients, two actually were diagnosed to have malignancy 3 and 5 years after their recommended surveillance scope date, respectively. CONCLUSIONS There is a very low compliance to post-polypectomy surveillance guidelines. More needs to be done to improve compliance to guidelines.
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Affiliation(s)
- Frederick H. Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore
| | - Dedrick K. H. Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingyu Ng
- Division of Colorectal Surgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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16
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Poor Knowledge of Colorectal Cancer Screening and Surveillance Guidelines in a National Cohort of Digestive Disease Specialists. Dig Dis Sci 2019; 64:391-400. [PMID: 30370490 DOI: 10.1007/s10620-018-5339-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/16/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is cost-effective and prevents death from CRC if used appropriately. Physicians do not recommend CRC screening according to guidelines. Physician-related factors associated with CRC screening knowledge are unknown. AIMS We tested the accuracy of CRC screening knowledge in a nationwide cohort of practicing and trainee physicians and assessed respondent's interest in a mobile app to improve appropriate CRC screening use. METHODS An electronic survey was emailed to practicing gastroenterology professionals and medical and surgical trainees. We assessed accuracy of responses compared to CRC screening and surveillance guidelines. We assessed factors associated with higher accuracy of knowledge, frequency of workplace smartphone use, and interest in a smartphone app to aid CRC screening and surveillance recommendations. RESULTS In total, 1432 responses were received. Hundred percent accuracy was noted in 22% of respondents for screening and 37% for surveillance. Factors associated with higher accuracy of screening guidelines included more recent training completion; academic practice; performing 21-100 colonoscopies per month (vs. < 21 or > 100). Higher accuracy of surveillance guidelines was associated with more recent training completion; academic practice; being a third-year fellow. In total, 53% use smartphones at least "often" in patient care. In total, 87% would use a CRC screening and surveillance smartphone app. CONCLUSIONS Accuracy in applying CRC screening guidelines by gastroenterologists is poor. Smartphone use for patient care is prevalent. Our data show a high interest in a CRC screening/surveillance mobile app. Mobile tools appear an opportunity for rapid access and an increased adherence to CRC screening guidelines.
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17
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Lung cancer screening: Practice guidelines and insurance coverage are not enough. J Am Assoc Nurse Pract 2019; 31:33-45. [PMID: 30431549 DOI: 10.1097/jxx.0000000000000096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Low-dose computed tomography (LDCT) is expected to increase early detection of lung cancer and improve survival. The growth in the number of advanced nurse practitioners (NPs) in primary care settings increases the likelihood that an NP will serve as a patient's provider. This study's purpose was to examine knowledge, attitudes, and practices regarding LDCT among NPs who work in primary care settings. METHODS An explanatory, sequential, mixed-method design used a 32-item questionnaire, followed by a semi-structured telephone interview. The development of the survey and interview questions were guided by a conceptual framework representing a temporal sequence for behavior change and potential barriers to guideline adherence. CONCLUSIONS Nurse practitioners believe that shared decision making with their high-risk patients about LDCT is within their scope of their practice. Working in time-constrained primary care settings, NPs have limited abilities to improve the uptake of LDCT. Substantial patient barriers exist that deter follow through on providers' recommendation. Disseminating guidelines and authorizing health insurance reimbursement is insufficient. IMPLICATIONS FOR PRACTICE Research is needed that investigates the screening process so that barriers can be closely studied. Culture change is needed where early detection has greater value for insurers, providers, and patients.
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18
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Predmore Z, Pannikottu J, Sharma R, Tung M, Nothelle S, Segal JB. Factors Associated With the Overuse of Colorectal Cancer Screening: A Systematic Review. Am J Med Qual 2018; 33:472-480. [PMID: 29546768 DOI: 10.1177/1062860618764302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This systematic review examined factors associated with overuse of colorectal cancer (CRC) screening. The authors searched MEDLINE and EMBASE from January 1998 to March 2017. Studies were included if they were written in English, contained original data, involved a US population, and examined factors potentially associated with overuse of CRC screening. Paired reviewers independently screened abstracts, assessed quality, and extracted data. In 8 studies, the associations between patient factors, including age, sex, race, and number of comorbidities, were tested and were inconsistently associated with CRC screening overuse. Overuse of screening was greater in the Northeast/Mid-Atlantic regions and in urban areas and was lower in academically affiliated centers. Although the literature supports important overuse of CRC screening, it remains unclear what drives these practices. Future research should thoroughly explore these factors and test the impact of interventions to reduce overuse of screening.
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Affiliation(s)
- Zachary Predmore
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jean Pannikottu
- 2 Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- 2 Johns Hopkins University School of Medicine, Baltimore, MD
| | - Monica Tung
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Stephanie Nothelle
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jodi B Segal
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,2 Johns Hopkins University School of Medicine, Baltimore, MD.,3 Johns Hopkins University Center for Health Services and Outcomes Research, Baltimore, MD
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19
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Mouchli MA, Ouk L, Scheitel MR, Chaudhry AP, Felmlee-Devine D, Grill DE, Rashtak S, Wang P, Wang J, Chaudhry R, Smyrk TC, Oberg AL, Druliner BR, Boardman LA. Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer. World J Gastroenterol 2018; 24:905-916. [PMID: 29491684 PMCID: PMC5829154 DOI: 10.3748/wjg.v24.i8.905] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/17/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the frequency and risk factors for colorectal cancer (CRC) development among individuals with resected advanced adenoma (AA)/traditional serrated adenoma (TSA)/advanced sessile serrated adenoma (ASSA).
METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp.
RESULTS 84/4610 (1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years (mean 4.89 years), and 1.2% (54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years (mean 6.67 years). Approximately, 30% (25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8% (15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC development at the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site.
CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.
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Affiliation(s)
- Mohamad A Mouchli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lidia Ouk
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Marianne R Scheitel
- Knowledge and Delivery Center, Mayo Clinic, Rochester, MN 55905, United States
| | - Alisha P Chaudhry
- Biostatistics and Bioinformatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Donna Felmlee-Devine
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Diane E Grill
- Division of Biomedical Statistics and Informatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Shahrooz Rashtak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Panwen Wang
- Biostatistics and Bioinformatics, Health Science Research, Center for Individualized Medicine Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Junwen Wang
- Biostatistics and Bioinformatics, Health Science Research, Center for Individualized Medicine Mayo Clinic, Scottsdale, AZ 85259, United States
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ 85259, United States
| | - Rajeev Chaudhry
- Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Center for Innovation, Mayo Clinic, Rochester, MN 55905, United States
| | - Thomas C Smyrk
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Ann L Oberg
- Division of Biomedical Statistics and Informatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Brooke R Druliner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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20
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Young LE, Sacks NC, Cyr PL, Sharma A, Dahdal DN. Comparison of claims data on hospitalization rates and repeat procedures in patients receiving a bowel preparation prior to colonoscopy. SAGE Open Med 2017; 5:2050312117727999. [PMID: 28894587 PMCID: PMC5582656 DOI: 10.1177/2050312117727999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To evaluate outcomes of colorectal screening using sodium picosulfate and magnesium citrate compared with other prescription bowel-preparation agents. Primary endpoints were rates of procedure-associated hospitalizations, diagnosis at hospitalization, and rates of early repeat screenings. METHODS This retrospective cohort study identified patients using the Truven Health Analytics MarketScan databases, which contain fully adjudicated, de-identified, medical- and prescription-drug claims, as well as demographic and enrollment information for individuals with commercial, Medicaid, and Medicare supplemental insurance coverage. Patients who had a colonoscopy or sigmoidoscopy over a 3-year period were identified using International Classification of Diseases Clinical Modification procedure codes, recorded on claims from physicians and facilities. First, screening colonoscopy was identified for each patient, and the study was limited to those patients who could be observed for ≥6 months before and 3 months after the screening procedure. Total number of hospitalizations and rates of early repeat screenings were evaluated for all patients who received sodium picosulfate and magnesium citrate and compared with those who received other bowel-preparation agents. Individual prescription medications that could affect the outcome of the cleansing agent were identified; further evaluations were made to establish whether patients had comorbid conditions, such as chronic kidney disease, cardiovascular disease, or psychiatric illness. Statistical methods included descriptive statistics, two-tailed t-tests, and multivariate logistic regression. RESULTS A total of 566,628 procedures were identified in the MarketScan databases and included in the study. Sodium picosulfate and magnesium citrate performed well in terms of safety outcomes, with no hospitalizations due to diagnosis of hyponatremia, dehydration, or other fluid disorders in the 10 days after procedure. Early repeat rates among sodium picosulfate and magnesium citrate patients were comparable with rates observed for all other cleansing agents. CONCLUSION Outcomes of colorectal screening using sodium picosulfate and magnesium citrate were not significantly different compared with other prescription bowel-preparation agents.
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Affiliation(s)
- Lisa E Young
- Ferring Pharmaceuticals Inc., Parsippany, NJ, USA
| | - Naomi C Sacks
- Precision Health Economics, Boston, MA, USA.,School of Medicine, Tufts University, Boston, MA, USA
| | - Philip L Cyr
- Precision Health Economics, Boston, MA, USA.,University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Abhishek Sharma
- Precision Health Economics, Boston, MA, USA.,Department of Global Health and Center for Global Health & Development, School of Public Health, Boston University, Boston, MA, USA
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21
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Tae CH, Moon CM, Kim SE, Jung SA, Eun CS, Park JJ, Seo GS, Cha JM, Park SC, Chun J, Lee HJ, Jung Y, Kim JO, Joo YE, Park DI. Risk factors of nonadherence to colonoscopy surveillance after polypectomy and its impact on clinical outcomes: a KASID multicenter study. J Gastroenterol 2017; 52:809-817. [PMID: 27830330 DOI: 10.1007/s00535-016-1280-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/23/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND An optimal surveillance program is important to prevent advanced colorectal neoplasm. In this context, we have evaluated the cumulative risk of high-risk adenoma (HRA) or colorectal cancer (CRC) according to surveillance interval time after polypectomy. In addition, we assessed risk factors for late surveillance to determine whether late surveillance can impact the risk of subsequent advanced colorectal neoplasm. METHODS This was a multicenter retrospective cohort study involving 3562 subjects who had undergone removal of at least one adenoma at the index colonoscopy and who subsequently underwent a surveillance colonoscopy. The subjects were classified into an early, appropriate or late group depending on the timing of the surveillance colonoscopy, performed using modified U.S. RESULTS With 3% of the study population with LRA and HRA at the index colonoscopy going on to develop HRA or CRC, the estimated surveillance intervals calculated would be 6.3 [95% confidence interval (CI) 5.42-7.10] years and 3.1 (95% CI 2.61-4.45) years, respectively. The predictors of late surveillance were female gender [odd ratio (OR) 1.21; 95% CI 1.04-1.40], having undergone the procedure in small-to-medium-sized cities (OR 1.92; 95% CI 1.36-2.72) and HRA at index colonoscopy (OR 1.37; 95% CI 1.19-1.59). The risk factors for subsequent HRA or CRC were late surveillance (OR 1.34; 95% CI 1.03-1.74), male gender (OR 2.13; 95% CI 1.54-2.95), having undergone the procedure in small-to-medium-sized cities (OR 1.63; 95% CI 1.11-2.40) and HRA at index colonoscopy (OR 2.60; 95% CI 2.04-3.33). CONCLUSIONS Women, having undergone the procedure in small-to-medium-sized cities and the presence of an HRA at the index colonoscopy were found to be independent risk factors for late surveillance colonoscopy. Late surveillance is significantly predictive of subsequent HRA or CRC.
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Affiliation(s)
- Chung Hyun Tae
- Department of Health Promotion Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chang Mo Moon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
| | - Seong-Eun Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Chang Soo Eun
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jae Jun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geom Seog Seo
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yunho Jung
- Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Jin Oh Kim
- Department of Internal Medicine, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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22
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Bartel MJ, Robertson DJ, Pohl H. Colonoscopy practice for veterans within and outside the Veterans Affairs setting: a matched cohort study. Gastrointest Endosc 2016; 84:272-8. [PMID: 26784365 DOI: 10.1016/j.gie.2016.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To minimize delays for colonoscopy within Veterans Affairs (VA) facilities, veterans may receive care at non-VA facilities based on fee-for-service contracts, and more recently, through the Veterans Access, Choice, and Accountability Act. The impact of diverting care from VA to non-VA facilities on quality of colonoscopy practice is unknown. METHODS We identified all veterans aged 50 to 85 years who received a fee-basis colonoscopy for colorectal cancer screening or surveillance at non-VA facilities in 2007 to 2010. These patients were matched for sex, age, and year of procedure to veterans who underwent colonoscopies at VA medical centers. The outcomes of interest were the adenoma detection rates (ADR) and compliance with surveillance guidelines. RESULTS During the observation period, 409 veterans (mean age 64 years; 94% men) underwent a fee-basis colonoscopy at 30 nonacademic (54%) and 2 academic (46%) facilities. Compared with colonoscopies performed at VA facilities, fee-basis colonoscopy patients had lower ADRs (38% vs 52%; P < .001), lower mean number of adenomas per procedure (0.72 vs 1.41; P < .001), and lower number of advanced ADRs (13% vs 22%; P < .001). Colonoscopies done at non-VA facilities were associated with lower ADRs in multivariate regression analysis (odds ratio 0.64; 95% CI, 0.44-0.92), whereas colonoscopies done in nonacademic settings or by colonoscopists who were not gastroenterologists were not. Compliance with surveillance guidelines was lower for colonoscopies performed outside VA facilities (80% vs 87%; P = .03). CONCLUSIONS In this regional study (Northern New England), compliance with colonoscopy surveillance guidelines was high in both VA and non-VA settings; however, lower ADRs raise concern that referring veterans outside the VA system may impact colonoscopy quality.
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Affiliation(s)
- Michael J Bartel
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Douglas J Robertson
- Department of Gastroenterology, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Heiko Pohl
- Department of Gastroenterology, White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Abstract
Quality metrics in colonoscopy are a growing area of focus given the development of and need for associated reporting and potential financial penalties. Three areas specifically have been identified as important by a multi-society task force, and the evidence behind each has been presented here. These metrics are adenoma detection rate, appropriate screening interval, and cecal intubation rate. Additional factors of interest include bowel preparation cleanliness and endoscope withdrawal time. Multifaceted interventions have been implemented to improve outcomes in colonoscopy with mixed success. Given that there are some quality metrics that have been shown to impact colorectal cancer outcomes, additional research should focus on disseminating these methods in a consistent and effective way across a myriad of practice models and patient populations.
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Affiliation(s)
- Katherine T Brunner
- Department of Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA,
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24
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Bogie R, Sanduleanu S. Optimizing post-polypectomy surveillance: A practical guide for the endoscopist. Dig Endosc 2016; 28:348-59. [PMID: 26179809 DOI: 10.1111/den.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/25/2015] [Accepted: 07/08/2015] [Indexed: 02/08/2023]
Abstract
Several gastrointestinal societies strongly recommend colonoscopy surveillance after endoscopic and surgical resection of colorectal neoplasms. Common denominators to these recommendations include: high-quality baseline colonoscopy before inclusion in a surveillance program; risk stratification based on clinicopathological profiles to guide surveillance intervals; and endoscopist responsibility for providing surveillance advice. Considerable variability also exists between guidelines (i.e. regarding risk classification and surveillance intervals). In this review, we examine key factors for quality of post-polypectomy surveillance practice, in particular bowel preparation, endoscopic findings at baseline examination and adherence to surveillance recommendations. Frequently asked questions by the practising endoscopist are addressed.
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Affiliation(s)
- Roel Bogie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silvia Sanduleanu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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25
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Calderwood AH. Adherence to Post-polypectomy Guidelines: Just One Piece of an Important Puzzle. Dig Dis Sci 2015; 60:2857-9. [PMID: 26108420 DOI: 10.1007/s10620-015-3767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Audrey H Calderwood
- Section of Gastroenterology, Department of Medicine, Boston Medical Center, 85 East Concord Street, Room 7724, Boston, MA, 02118, USA.
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26
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Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system. Cancer Causes Control 2015; 26:1653-60. [PMID: 26376891 DOI: 10.1007/s10552-015-0661-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/03/2015] [Indexed: 12/24/2022]
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.
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