Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network

Jennifer L. Holub, Cynthia Morris, Lyle Fagnan, Judith (Judy) Logan, Leann C. Michaels, David Lieberman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. Methods: The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. Results: No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106). Conclusion: ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.

Original languageEnglish (US)
JournalJournal of Rural Health
DOIs
StateAccepted/In press - 2017

Fingerprint

Colonoscopy
Outcome Assessment (Health Care)
Research
Physicians
Cecum
Early Detection of Cancer
Colonic Neoplasms
Databases

Keywords

  • Colonoscopy
  • Primary care
  • Quality
  • Rural

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

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title = "Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network",
abstract = "Purpose: Colon cancer screening is effective. To complete screening in 80{\%} of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. Methods: The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. Results: No ORPRN physicians were gastroenterologists compared with 82{\%} of nonrural physicians. ORPRN practices reached the cecum in 87.4{\%} of exams compared with 89.3{\%} of rural sites (P = .0002) and 90.9{\%} of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7{\%} vs 91.6{\%}; P < .0001) and sent to pathology (77.1{\%} vs 91.3{\%}; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0{\%} vs 40.3{\%}) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8{\%} at ORPRN sites, compared to 26.8{\%} at nonrural sites (P < .0001), and for polyps >9mm 16.6{\%} vs 18.7{\%} (P = .106). Conclusion: ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.",
keywords = "Colonoscopy, Primary care, Quality, Rural",
author = "Holub, {Jennifer L.} and Cynthia Morris and Lyle Fagnan and Logan, {Judith (Judy)} and Michaels, {Leann C.} and David Lieberman",
year = "2017",
doi = "10.1111/jrh.12231",
language = "English (US)",
journal = "Journal of Rural Health",
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TY - JOUR

T1 - Quality of Colonoscopy Performed in Rural Practice

T2 - Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network

AU - Holub, Jennifer L.

AU - Morris, Cynthia

AU - Fagnan, Lyle

AU - Logan, Judith (Judy)

AU - Michaels, Leann C.

AU - Lieberman, David

PY - 2017

Y1 - 2017

N2 - Purpose: Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. Methods: The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. Results: No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106). Conclusion: ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.

AB - Purpose: Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. Methods: The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. Results: No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106). Conclusion: ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.

KW - Colonoscopy

KW - Primary care

KW - Quality

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