Community Education, Media and Motivational Interviewing: Colonoscopy Screening Attitudes Among African-Americans in Baltimore, MD (original) (raw)
2016, American Journal of Gastroenterology
Introduction: Colonoscopy is the most common method to diagnose colon cancer. Colon cancer is the second leading cause of cancer death in our country. Th e adenoma detection rate has been recommended as one of the main quality indicator. Th e adenoma detection rate (ADR) is 25%. ADR is 30 % for men and 20% for women. ADR is the quality indicator with the strongest association to post-colonoscopy colorectal cancer or missed colorectal cancer. Improved adenoma detection rate will decrease the incidence of post-colonoscopy colorectal cancer. Newer studies have shown that for each 1% increase in ADR, risk of "missed" CRC decreases by 3%. Th ere are very few studies regarding the adenoma detection rate in Colonoscopy performed in a small ambulatory surgery center. Methods: All patients who underwent screening colonoscopies in our ambulatory surgery center between 2013 to 2015 were included in the data analysis. Th e ADR is defi ned as the number of patients out of every 100 undergoing fi rst time screening colonoscopy who have at least one adenoma removed. Th e withdrawl time was more than 6 minutes in all the screening colonoscopies. Th e cecal intubation rate was 96.8% in our center. Most of the patient's used split dose colonic prep. Th e patient's with incomplete colonoscopy secondary to poor prep was excluded from the analysis. Results: Th ere were 4486 procedures performed by two physicians in our ambulatory surgery center. 54.3 % were colonoscopies, 28.8% were upper endoscopies, 0.2 were fl exible sigmoidoscopies. 16.6 % were minor surgical procedures like skin abscess drainage, port placement. 616 patient's underwent screening colonoscopies. Th e mean age of screening colonoscopy group was 58.6 years. Our youngest patient was 50 years old and the oldest was 79 years old. 58.2 % were females and 41.8% were males. 291 patients were found to have adenoma giving adenoma detection rate of 47%. Conclusion: High adenoma detection rate can be achieved in small community ambulatory surgery center provided high quality measures like high cecal intubation rate, good quality prep, increased withdrawl time are achieved diligently. Newer technologies like Fusion scope by Endochoice will also increase the adenoma detection rate. ADR as a quality measure are now being tracked by Medicare and commercial insurance companies. Added pay for performance ADR benchmarks being considered and granted by some commercial payers.
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