Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured.
Prev Chronic Dis
; 16: E67, 2019 05 30.
Article
en En
| MEDLINE
| ID: mdl-31146803
ABSTRACT
INTRODUCTION:
Screening can decrease colorectal cancer incidence and mortality and is recommended in clinical practice guidelines. Poor quality of colorectal cancer screening can negate the benefit of screening. The objective of this study was to assess the quality of screening services provided by the Centers for Disease Control and Prevention's Colorectal Cancer Control Program from July 2009 through June 2015.METHODS:
We collected data from the program's 29 grantees, funded to provide colorectal cancer screening and diagnostic services to asymptomatic, low-income, and underinsured or uninsured adults aged 50 to 64. We collected data on the dates and results of all screening and diagnostic tests and, for colonoscopies, on whether the cecum was reached, whether bowel preparation was adequate, and endoscopists' recommendations for the next test.RESULTS:
Overall, 82.9% (range among grantees, 50.0%-97.2%) of positive FOBTs/FITs were followed up by colonoscopy; 95.2% of colonoscopies occurred within 180 days of the positive stool test. Cecal intubation rates ranged among grantees from 94.2% to 100%. Adenoma detection rates met recommended threshold levels for almost all grantees. Recommendations for rescreening and surveillance intervals deviated from guidelines in both directions. Of clients with normal colonoscopies, 85.3% (range, 37.7%-99.7%) were told to return in 10 years, as recommended in national guidelines. Of clients with advanced adenomas, 55.2% (range, 20.0%-84.6%) were told to return in 3 years as recommended, 25.4% (range, 3.8%-56.6%) in 5 or more years, and 18.6% (range, 0%-47.2%) in less than 3 years.CONCLUSION:
Although overall screening quality was good, it varied considerably. Ongoing monitoring to identify performance problems is essential for all colorectal cancer screening activities, so that efforts designed to improve performance can be targeted to individual clinicians.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Calidad de la Atención de Salud
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Neoplasias Colorrectales
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Tamizaje Masivo
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Colonoscopía
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Pacientes no Asegurados
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Centers for Disease Control and Prevention, U.S.
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Detección Precoz del Cáncer
Tipo de estudio:
Diagnostic_studies
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Guideline
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Incidence_studies
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Prognostic_studies
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Screening_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País como asunto:
America do norte
Idioma:
En
Año:
2019
Tipo del documento:
Article