S278 Assessing Adherence to Recommending 10-Year Intervals After Normal Screening Colonoscopy in Average-Risk Individuals Based on Specialty and Practice Status

Abstract

Introduction: After a normal average-risk CRC screening colonoscopy, endoscopists should recommend repeat screening in 10 years. Target is 90% adherence per guidelines, and this has been a priority quality indicator for CMS Medical Incentive Payment System and the ACPs Choosing Wisely Program. Our 2017 quality improvement (QI) project showed poor adherence (less than 40%) among private gastroenterologists and academic surgeons. Prior to commencing a new QI initiative, this project assessed frequency of adherence in 2021 at a single site. Methods: Inclusion criteria: To minimize confounders, patients were limited to: (a) average-risk, 50-82 year old; (b) colonoscopy performed in 2021; (c) sole indication of CRC screening; (d) no biopsy, polypectomy, or reference to abnormal findings on procedure report. Study Setting: Hospital-based “open” endoscopy suite (i.e., utilized by academic/private gastroenterologists and academic surgeons) at an academic tertiary care center. Primary Outcome: Adherence to guideline intervals defined as repeat colonoscopy in 10 years, discontinuation of CRC screening due to patient’s age when bowel preparation is adequate or repeat colonoscopy within 1 year if bowel preparation is poor/inadequate. Adherence rates stratified by specialty and type of practice: academic gastroenterologist (n = 7), academic surgeon (n = 3), or private gastroenterologist (n = 6). Differences in adherence between groups assessed using chi-square analysis. Results: Among 465 eligible patients, mean age was 60.1 +/- 8.2 years, 38.5% male, and 76.8% African American. Adherence surpassed target of 90% adherence for academic gastroenterologists (total=96.0%) with (96.9%) or without GI fellows (88.9%) and was superior to adherence by private gastroenterologists or academic general surgeons (p < 0.001). The latter two groups were adherent in 32.4% and 42.3%, respectively (Figure). Adherence was significantly better with good/excellent bowel preps (71.8%) compared to other bowel prep categories (p< 0.001), and patients with poor, fair, or no documentation of prep were adherent in 42.1% (Table). Conclusion: In this project, adherence among academic gastroenterologist met guideline-specified target of 90% when a gastroenterology fellow participated in the procedure. In all other groups, adherence did not meet the recommended threshold. These data are similar to our 2017 QI project and identify an excellent opportunity for a quality intervention educational and monitoring project to improve performance.Figure 1.: Adherence to Guidelines per Endoscopic Specialty Table 1. - Adherence to Recommended Intervals stratified by Bowel Preparation Bowel Preparation Adherence to Recommended Intervals* P-value No Documentation 42.9% (9/21) < 0.001 Poor/Inadequate 62.2% (28/45) Fair 19.5% (8/41) Good/Excellent 71.8% (257/358) *Adherence to recommended intervals by guidelines defined as a 10-year repeat colonoscopy recommendation if colonoscopy was normal in an average-risk individual, < 1 year was recommended if the bowel preparation was inadequate, or repeat colonoscopy not recommended if patient was ≥66 years at time of normal colonoscopy.