Although guidelines recommend a 10-year interval for screening colonoscopy, up to 60% of average-risk patients with a normal colonoscopy are recommended to return for repeat screening colonoscopy in <10 years. Overuse of screening colonoscopy wastes billions of dollars and reduces colonoscopy capacity for appropriate use. Understanding the reasons why physicians recommend shorter intervals is critical to designing successful interventions to prevent overuse. In addition, establishing that self-reported recommendation practices are reasonably accurate will facilitate future investigations of overuse.
The specific aims of this study are 1) to identify the determinants of recommendations for repeat screening colonoscopy among average risk patients and 2) to directly compare physician self-reported screening recommendations to recommendations documented in medical records To accomplish these specific aims, the study will be conducted in collaboration with the Clinical Outcomes Research Initiative (CORI), which includes 70 practice sites (hospitals, ambulatory care centers, private practices, universities) in 24 states. The National Institutes of Health (NIH) has funded the CORI consortium to provide an endoscopy registry for research and quality improvement. Participating physicians use the CORI electronic endoscopy report program to generate the colonoscopy report for clinical use, and then the reports are electronically sent to a central data repository in the National Endoscopic Database (NED). This study will use the NED to obtain physician recommendations for repeat screening colonoscopy. Preliminary NED data (2009-2011) indicate that over 15,000 normal colonoscopies were performed for average risk screening by 315 CORI physicians. For the first aim, a previously developed and pilot-tested survey will be administered to all CORI physicians who have performed a normal colonoscopy for average risk screening. to assess the role of knowledge, attitudes, subjective norms, and external factors in physician recommendations for screening colonoscopy intervals. The expected sample is at least 120 physicians. For the second aim, self-reported recommendation behavior measured by the questionnaire and the recommendation as documented in the NED will be compared. We will ultimately use the information generated by this study to develop an intervention to prevent colonoscopy overuse.
Overuse of repeat screening colonoscopy is common and estimated to waste billions of dollars as well as place patients at risk without clear benefit. Understanding the reasons why physicians recommend screening intervals that differ from published guidelines is critical to designing successful interventions to prevent overuse of colonoscopy.