UICC World Cancer Congress 2006

Objective: To maximize the benefits and minimize the harms associated with screening, clinicians should follow recommended guidelines for test implementation. However, many primary care physicians in the United States do not implement fecal occult blood testing appropriately. They use inaccurate single-sample in-office tests rather than the recommended home tests and, to follow up positive results, many repeat the test rather than recommending total colon examination. Increasingly, colonoscopy is being used for screening, but the quality of performance in clinical practice varies. The best documented area of variation is the sensitivity for colorectal neoplasia. Identified problems include low cecal intubation rates, inadequate time spent performing the procedure, and performing surveillance colonoscopy at shorter intervals than recommended in guidelines. Endoscopists should routinely monitor their own performance and compare it to continuous quality improvement (CQI) targets.

Methods: The Multi-Society Task Force on Colorectal Cancer published specific recommendations to improve the quality of colonoscopy, highlighting key indicators for CQI. An obstacle to measuring quality has been the absence of a standardized reporting system for colonoscopy. The Quality Assurance Task Group of the National Colorectal Cancer Roundtable, which includes endoscopists and primary care providers, reviewed each quality indicator, updated the literature review for each topic, and developed consensus around the optimal method of endoscopic reporting which would capture the quality indicator.

Results: The standardized colonoscopy reporting and data system (CO-RADS) includes elements on patient demographics and history, assessment of patient risk, procedure indications, technical aspects of the examination, colonoscopic findings, complications, and follow-up plan. It provides endoscopists with a tool for reporting which should facilitate the monitoring of quality and it provides referring physicians a colonoscopy report that uses standard terms and follow-up recommendations.