ArticleDiseases of the colon and rectum2025
Barriers to Colonoscopy Quality Measurement in Rural Wisconsin.
Article in Diseases of the colon and rectum, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Adherence to Multitarget Stool DNA Testing in Individuals Aged 45-49 Years With Average Risk for Colorectal Cancer.Clinical and translational gastroenterology · 2025Article
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Abstract
backgroundPatients in rural areas have limited colonoscopy access, which is critical for colorectal cancer prevention. General surgeons perform most colonoscopies in rural areas. The Surgical Collaborative of Wisconsin's Rural Task Force identified colonoscopy as a high-priority initiative due to high volume and lack of access to quality measurement, which is necessary to assess and ultimately improve colonoscopy performance.
objectiveAssess the capacity for colonoscopy quality measurement and improvement in rural Wisconsin hospitals.
designFrom October 2019 to January 2020, the Surgical Collaborative of Wisconsin, Rural Wisconsin Health Cooperative, and Wisconsin Collaborative for Healthcare Quality collaborated to design and distribute a survey to 44 Rural Wisconsin Health Cooperative hospitals. Descriptive statistics summarized survey items. Surgeons from 6 rural hospitals participated in stakeholder interviews.
settingRural Wisconsin Health Cooperative hospitals.
main outcome measuresColonoscopy providers, procedure volume/capacity, informatics and quality measurement infrastructure, barriers to quality measurement, and improvement.
resultsTwenty-five surveys (57%) were completed. Most colonoscopy providers in rural hospitals were surgeons (66.3%), followed by family/internal medicine physicians (20.0%) and gastroenterologists (13.8%). The average hospital volume/week was 19.9 colonoscopies (SD = 13.4). Hospitals reported operating at ~75% capacity. Withdrawal time was the most tracked measure (44.0%), followed by adenoma detection (36.0%) and cecal intubation (28.0%) rates. Approximately one-third of hospitals (36.0%) used procedure-reporting software. Most hospitals (80.0%) did not have access to on-site pathology. Surgeons reported barriers to quality measurement/improvement, including insufficient resources for electronic medical record-based reporting and the need for targeted educational opportunities that do not require travel. LIMITATIONS: Single state may not represent the experience of all rural hospitals.
conclusionsThe lack of access to colonoscopy quality measures suggests the opportunity to develop a flexible approach that considers reporting software availability and electronic medical record differences. Improving access to measures and education/training opportunities may improve the availability of high-quality colonoscopies for patients in rural Wisconsin. See Video Abstract . BARRERAS PARA LA MEDICIN DE LA CALIDAD DE LA COLONOSCOPIA EN LAS ZONAS RURALES DE WISCONSIN: ANTECEDENTES:Los pacientes de las zonas rurales tienen un acceso reducido a la colonoscopia, que es fundamental para la prevención del cáncer colorrectal. Los cirujanos generales realizan la mayoría de las colonoscopias en las zonas rurales. El Surgical Collaborative of Wisconsin's Rural Task Force identificó la colonoscopia como una iniciativa de alta prioridad debido al alto volumen y a la falta de acceso a medidas de calidad, ambas necesarias para evaluar y mejorar el rendimiento.OBJETIVO:Evaluar la capacidad de medición y mejora de la calidad de la colonoscopia en los hospitales rurales de Wisconsin.DISEÑO:En octubre de 2019-enero de 2020, el Surgical Collaborative of Wisconsin, el Rural Wisconsin Health Cooperative y el Wisconsin Collaborative for Healthcare Quality colaboraron para diseñar y distribuir una encuesta a 44 hospitales del Rural Wisconsin Health Cooperative (n = 25 completados, tasa de respuesta del 57%). Las estadísticas descriptivas resumieron los ítems de la encuesta. Los cirujanos de cada uno de los seis hospitales rurales participaron en entrevistas con las partes interesadas.ÁMBITOS Y PACIENTES:Hospitales rurales de la Cooperativa de Salud de Wisconsin.PRINCIPALES MEDIDAS DE VALORACIÓN:Proveedores de colonoscopia, volumen y capacidad de procedimientos, infraestructura informática y de medición de la calidad, barreras a la medición y mejora de la calidad.RESULTADOS:La mayoría de los proveedores de colonoscopias de los hospitales rurales eran cirujanos (66,3%), seguidos de médicos de familia o médicos internos (20,0%) y gastroenterólogos (13,8%). El volumen hospitalario medio por semana fue de 19,9 colonoscopias (DE = 13,4). Los hospitales declararon operar a ~75% de su capacidad. El tiempo de retirada fue la medida más seguida (44,0%), seguida de las tasas de detección de adenomas (36,0%) y de intubación cecal (28,0%). Aproximadamente un tercio de los hospitales (36,0%) utilizaba programas informáticos de notificación de procedimientos. La mayoría de los hospitales (80,0%) no tenían acceso a patología in situ. Los cirujanos señalaron obstáculos a la medición y mejora de la calidad, como la insuficiencia de recursos para la elaboración de informes basados en historias clínicas electrónicas y la necesidad de oportunidades de formación específicas que no requieran desplazamientos.LIMITACIONES:Un solo estado; puede no representar la experiencia de todos los hospitales rurales.CONCLUSIONES:La falta de acceso a las medidas de calidad de la colonoscopia sugiere la oportunidad de desarrollar un enfoque flexible que tenga en cuenta la disponibilidad de software de notificación y las diferencias en los registros médicos electrónicos. Mejorar el acceso a las medidas y las oportunidades de educación y formación puede mejorar la disponibilidad de colonoscopias de alta calidad para los pacientes de las zonas rurales de Wisconsin. (Traducción--Ingrid Melo).
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