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Research ArticleOriginal Research

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program

David A. McClellan, Chinedum O. Ojinnaka, Robert Pope, John Simmons, Katie Fuller, Andrew Richardson, Janet W. Helduser, Phillip Nash, Marcia G. Ory and Jane N. Bolin
The Journal of the American Board of Family Medicine November 2015, 28 (6) 713-721; DOI: https://doi.org/10.3122/jabfm.2015.06.140342
David A. McClellan
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
MD
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Chinedum O. Ojinnaka
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
MBBS, MPH
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Robert Pope
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
MD
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John Simmons
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
MD
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Katie Fuller
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
DO
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Andrew Richardson
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
MD
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Janet W. Helduser
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
MA
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Phillip Nash
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
BSc
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Marcia G. Ory
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
PhD, MPH
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Jane N. Bolin
From the Department of Clinical & Translational Medicine, College of Medicine, Texas A&M University, Bryan (DAM, RP, JS, KF, AR); Texas A&M Physicians Family Medicine Residency, Texas A&M University, Bryan (DAM, RP, JS, KF, AR, PN); the Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station (COO, JWH, JNB); and the Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station (MGO).
PhD, JD, BSN
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Article Figures & Data

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    Table 1. Descriptive Statistics of Select Patient Characteristics by Rural/Urban Residence
    Urban (n = 706)Rural (n = 389)Total (n = 1095)P Value
    Mean age (years)64.4735.53.57
    Sex.644
        Female497 (70.40)279 (71.72)776 (70.87)
        Male209 (29.60)110 (28.28)319 (29.13)
    Race/ethnicity.000
        White191 (27.48)180 (46.75)371 (34.35)
        Black/African American165 (23.74)81 (21.04)246 (22.78)
        Hispanic/Latino304 (43.74)113 (29.35)417 (38.61)
        Other35 (5.04)11 (2.86)46 (4.26)
    Health insurance.000
        No478 (68.48)329 (86.58)807 (74.86)
        Yes220 (31.52)51 (13.42)271 (25.14)
    Family history of adenomatous polyps or cancer
        No336 (70.15)188 (58.93)524 (65.66)
        Yes126 (26.30)106 (33.23)232 (29.07)
        Unknown/don't know17 (3.55)25 (7.84)42 (5.26)
    Previous CRC screening using any test for among those above age 50
        No338 (64.38)184 (58.79)522 (62.29)
        Yes184 (35.05)116 (37.06)300 (35.80)
        Unknown/don't know3 (0.57)13 (4.15)16 (1.91)
    Previous colonoscopy among those above age 50.044
        No384 (73.14)230 (73.48)614 (73.27)
        Yes132 (25.14)69 (22.04)201 (23.99)
        Unknown/don't know9 (1.71)14 (4.47)23 (2.74)
    Previous Fecal Occult Blood Test (FOBT)/Fecal Immunochemical Test (FIT) among those above age 50.016
        No264 (75.43)168 (66.40)432 (71.64)
        Yes72 (20.57)63 (24.90)135 (22.39)
        Unknown/don't know14 (4.00)22 (8.70)36 (5.97)
    Previous CRC screening among those aged ≥50 years who have a positive family history
        No35 (37.23)44 (47.83)79 (42.47)
        Yes58 (61.70)44 (47.83)102 (54.84)
        Unknown/don't know1 (1.06)4 (4.35)5 (2.69)
    Previous colonoscopy among those aged ≥50 years who have a positive family history
        No47 (50.00)62 (67.39)109 (58.60)
        Yes43 (45.74)26 (28.26)69 (37.10)
        Unknown/don't know4 (4.26)4 (4.35)8 (4.30)
    Previous FOBT/FIT among those age 50 and above who have a positive family history.353
        No58 (62.37)51 (57.30)109 (59.89)
        Yes30 (32.26)28 (31.46)58 (31.87)
        Unknown/don't know5 (5.38)10 (11.24)15 (8.24)
    Procedure results
        Precursors.50
            No499 (73.82)283 (72.01)782 (73.15)
            Yes177 (26.18)110 (27.99)287 (26.85)
        Cancer.003
            No674 (99.70)384 (97.71)1058 (98.97)
            Yes2 (0.30)9 (2.29)11 (1.03)
    • Data are n (%) unless otherwise indicated.

    • CRC, colorectal cancer; FOBT, fecal occult blood test; FIT, fecal immunochemical testing.

    • View popup
    Table 2. Quality Indicators of Colonoscopy Procedures
    Texas C-STEPASGE Recommendation
    Cecum attained, n (%)1066 (96.25)≥95%
    Adenoma detection rate among men and women ≥50 years old, n (%)840 (29.59)
    Adenoma detection rate among women ≥50 years old, n (%)570 (25.70)≥15%
    Adenoma detection rate among men ≥50 year, n (%)270 (38.18)≥25%
    Mean total withdrawal time (minutes)1023 (18)≥6 minutes
    Perforation rate1155 (1 in 1155)1 in 1000
    Post polypectomy bleed, n (%)1155 (0.17)<1%
    • ASGE, American Society for Gastrointestinal Endoscopy; C-STEP, Cancer Screening, Training, Education and Program.

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The Journal of the American Board of Family     Medicine: 28 (6)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 6
November-December 2015
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Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program
David A. McClellan, Chinedum O. Ojinnaka, Robert Pope, John Simmons, Katie Fuller, Andrew Richardson, Janet W. Helduser, Phillip Nash, Marcia G. Ory, Jane N. Bolin
The Journal of the American Board of Family Medicine Nov 2015, 28 (6) 713-721; DOI: 10.3122/jabfm.2015.06.140342

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Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program
David A. McClellan, Chinedum O. Ojinnaka, Robert Pope, John Simmons, Katie Fuller, Andrew Richardson, Janet W. Helduser, Phillip Nash, Marcia G. Ory, Jane N. Bolin
The Journal of the American Board of Family Medicine Nov 2015, 28 (6) 713-721; DOI: 10.3122/jabfm.2015.06.140342
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