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Measuring and Improving Quality of Colonoscopy for Colorectal Cancer Screening

  • Christopher V. Almario
    Correspondence
    Corresponding author.
    Affiliations
    Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA

    Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Cancer Prevention & Control Program, Cedars-Sinai Cancer, Los Angeles, CA, USA
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  • Jaspreet Shergill
    Affiliations
    Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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  • Janice Oh
    Affiliations
    Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Published:November 14, 2021DOI:https://doi.org/10.1016/j.tige.2021.11.002

      ABSTRACT

      Colorectal cancer (CRC) is largely preventable, yet it remains a major public health issue as it is the third most common and deadly malignancy in the U.S. While there are many ways to screen for CRC, colonoscopy remains the gold standard as it is the only test that is both cancer-detecting and cancer-preventing through removal of pre-cancerous polyps. Through identifying and removing neoplastic lesions, colonoscopy reduces CRC incidence by 31%-91% and CRC mortality by 65%-88%. However, colonoscopy is not an infallible test—there is a chance for missed lesions during the exam and there is substantial variation in outcomes among endoscopists. To enhance the quality of colonoscopic exams, and ultimately to improve CRC outcomes, quality indicators have been developed for measuring endoscopists’ performance. In this review, we describe the colonoscopic quality indicators and benchmarks recommended by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy for screening colonoscopies in average-risk individuals. Measuring and monitoring endoscopists’ performance on these measures are critical first steps in striving towards conducting high quality exams. We also review the evidence for interventions that aim to improve critical measures including adenoma detection rate, withdrawal time, cecal intubation, and bowel preparation quality. Finally, we provide a preview of the forthcoming Advancing Care for Appropriate Colon Health Merit-Based Incentive Payment System Value Pathway by the Centers for Medicare & Medicaid Services and its potential impact on clinical practice.

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