Mo1957 Evaluation of the Performance Characteristics of a Regional Colon Cancer Screening Program

Abstract

Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) Program was created as the Edmonton medical zone arm of the Alberta Colorectal Cancer Screening Program (ACRCSP). The aim of the program was to provide consistent, high quality colon cancer screening while adhering to provincial, national and international screening and endoscopic quality guidelines. AIM To evaluate the quality of colonoscopy and colon cancer screening completed during the first year of the SCOPE program and to assess the impact of the endoscopist's area of expertise on outcomes. METHOD All colonoscopies performed in 2012 through the SCOPE program were assessed for polyp detection rate (PDR), adenoma detection rate (ADR), withdrawal time and rectal retroflexion and then stratified based on the specialty of endoscopist performing the procedure. Data was derived retrospectively from the dictated reports and pathology findings. RESULTS From January 1 to December 31, 2012, a total of 3013 screening colonoscopies were performed through the SCOPE program. Gastroenterologists (GI) performed the majority of the cases (2353), with the remaining cases being performed byGeneral Surgeons (GS)(331), Internists (IM)(221), or a Nurse practitioner (NP)(108). The overall mean PDR and ADR for the program was 53% and 35% respectively. The mean ADR was highest amongst GI (37%) and significantly different compared to GS (27%) (p < 0.001) but not statistically different from IM (31%)(p=0.09) or to nurse practitioner (NP) (32%)(p=0.24). GI had significantly longer withdrawal times compared to GS (6.82 min vs. 5.92 min; p<0.001) and to IM (6.82 min vs. 4.08 min; p < 0.001) but no different compared to the NP (6.82 min vs. 7.17 min; p=0.07). The highest mean retroflexion reporting rate was achieved by IM at 93%, which was significantly superior to GI (81%), NP (82%) and GS (52%), all with p < 0.0001. Both GI and NP had significantly higher retroflexion reporting rates than GS (each p < 0.001), but were similar between GI and NP (p=0.91). CONCLUSION The SCOPE program currently meets endoscopic quality standards for overall ADR and withdrawal time, even though there is some variability in the quality of colonoscopy between specialties. This data represents a baseline standard, allowing individual endoscopists participating in the SCOPE program to reflect on areas to maintain or improve patient care through high quality colorectal cancer screening.