Research
Colonoscopy
Colorectal cancer is the second leading cause of cancer-related
deaths in the United States. Most colorectal cancers and deaths that
occur in persons at average risk are preventable through screening.
The U.S. Preventive Services Task Force (USPSTF) recommends that
individuals aged fifty and older who are asymptomatic and at average
risk for colorectal cancer should be screened regularly. Current
USPSTF guidelines for colorectal cancer screening indicated there is
insufficient evidence to determine the most efficacious screening
method, a recommendation supported by Walsh and Terdiman in 2003.
However, the American College of Gastroenterology recently reported
that colonoscopy is the best colorectal cancer prevention test
currently available.
Due to the change in the screening recommendation and because
Medicare recently enhanced the reimbursement policy to extend
coverage of screening colonoscopy to average risk beneficiaries
every ten years, there may be insufficient numbers of trained
colonoscopists to perform the screening procedure. One strategy to
meet this demand is to increase the number of family physicians
trained in colonoscopy.
Family physicians trained in colonoscopy will help meet the
increasing demand for cost effective screening to diverse
populations, will provide access to care in rural and medically
underserved areas and will help substantially reduce colorectal
cancer morbidity and mortality in the future. Before family
physicians can be considered a viable choice for colorectal cancer
screening, there needs to be a current, more in-depth study of the
efficacy and safety of this procedure when done by family
physicians. Previous studies are over 10 years old and had a very
limited number of providers and a small number of cases that were
evaluated.
The overall purpose of this research project is to evaluate the
quality of colonoscopy performed by twenty two family physicians who
are members of the Indiana Family Practice Research Network.
Objectives of this research are to determine if family physicians
who perform colonoscopy meet the accepted quality of care standards
to perform the procedure. Primary measures: cecal intubation rates,
adverse events rates, and pathology rates will be compared to
accepted standards using means and z-tests for proportions, where
appropriate.
