Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study

AbstractObjectivesTo quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.DesignPopulation ba...

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Veröffentlicht in:BMJ (Online) Jg. 367; S. l6090
Hauptverfasser: Burr, Nicholas E, Derbyshire, Edmund, Taylor, John, Whalley, Simon, Subramanian, Venkataraman, Finan, Paul J, Rutter, Matthew D, Valori, Roland, Morris, Eva J A
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England BMJ Publishing Group LTD 13.11.2019
BMJ Publishing Group Ltd
Schlagworte:
Age
Aged
Cancer
Cancer screening
Cohort analysis
Colonoscopy
Colonoscopy - methods
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - diagnosis
Colorectal Neoplasms - epidemiology
Disease
Early Detection of Cancer - methods
Early Detection of Cancer - standards
Early Detection of Cancer - statistics & numerical data
Endoscopy
England - epidemiology
Female
Gastroenterology
Health risk assessment
Health services
Humans
Incidence
Inflammatory bowel diseases
Intestine
Male
Medical screening
Middle Aged
Mortality
Polyps
Population
Population studies
Population-based studies
Public health
Quality
Quality control
Quality Improvement - organization & administration
Risk Factors
State Medicine - standards
Tumors
Variation
England
United Kingdom > UK
ISSN:0959-8138, 1756-1833, 1756-1833
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Zusammenfassung:AbstractObjectivesTo quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.DesignPopulation based cohort study.SettingNational Health Service in England between 2005 and 2013.PopulationAll people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr).Main outcome measuresNational trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers.ResultsThe overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix.ConclusionsWide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0959-8138
1756-1833
1756-1833
DOI:10.1136/bmj.l6090