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Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program

. 2013 Aug 1;119 Suppl 15(0 15):2834-41. doi: 10.1002/cncr.28164. Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program

Affiliations

Affiliation

¹ Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mrn1@cdc.gov

PMID: 23868477
PMCID: PMC4479171
DOI: 10.1002/cncr.28164

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Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program

Marion R Nadel et al. Cancer. 2013.

. 2013 Aug 1;119 Suppl 15(0 15):2834-41. doi: 10.1002/cncr.28164. Affiliation

¹ Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mrn1@cdc.gov

PMID: 23868477
PMCID: PMC4479171
DOI: 10.1002/cncr.28164

Item in Clipboard

Abstract

Background: Gaps in screening quality in community practice have been well documented. The authors examined recommended indicators of screening quality in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program (CRCSDP), which provided colorectal cancer screening and diagnostic services between 2005 and 2009 for asymptomatic, low-income, underinsured, or uninsured individuals at 5 sites around the United States.

Methods: For each client screened in the CRCSDP, a standardized set of colorectal cancer clinical data elements was collected. Data regarding client age, screening history, risk level, screening test indication, results, and recommendation for the next test were analyzed. For colonoscopies, data were analyzed regarding whether the cecum was reached, bowel preparation was adequate, and identified lesions were completely removed.

Results: Overall, 53% of the fecal occult blood tests (FOBTs) (2295 tests) distributed were completed and returned. At the 2 sites with adequate numbers of FOBTs, 77% and 97%, respectively, of clients with positive results received follow-up colonoscopies. Site-specific cecal intubation rates ranged from 90% to 98%. Adenoma detection rates were 32% for men and 21% for women. For approximately one-third of colonoscopies, the recommended interval to the next test was shorter than recommended by national guidelines. At some sites, endoscopists failed to report on the adequacy of bowel preparation and completeness of polyp removal.

Conclusions: Cecal intubation rates and adenoma detection rates met recommended levels. The authors identified the need for improvements in the follow-up of positive FOBTs, documentation of important elements in colonoscopy reports, and recommendations for rescreening or surveillance intervals after colonoscopy. Monitoring quality indicators is important to improve screening quality.

Keywords: colonoscopy; colorectal neoplasms; fecal occult blood; health care; mass screening; quality indicators.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

Figures
Figure 1

The follow-up of positive fecal…

Figure 1

The follow-up of positive fecal occult blood tests (FOBTs) with colonoscopy is shown…

Figure 1

The follow-up of positive fecal occult blood tests (FOBTs) with colonoscopy is shown for the areas of Nebraska and Greater Seattle in the Centers for Disease Control and Prevention’s Colorectal Cancer Screening Demonstration Program, 2005 through 2009.