Colonoscopy Quality and Patients' Colonoscopist Selection
Colonoscopy Quality and Patients' Colonoscopist Selection
Adults (>18 years) presenting for outpatient screening or surveillance colonoscopy to endoscopy centers at Yale-New Haven Hospital and Yale Health Outpatient Facility (May 2011—June 2012), Griffin Hospital (February 2012—June 2012), were eligible to participate in the study. These centers represent university-affiliated and community centers serving patients from lower, middle, and upper socioeconomic strata. Study participants completed a survey before undergoing colonoscopy. Patients who were unable to provide consent and non-English speaking patients were excluded. This study was approved by the Institutional Review Board at each site.
A 15-question survey was developed to assess patients' knowledge of CQMs. The questionnaire was initially piloted on 10 subjects. The survey was structured to be completed in 7–10 min and was administered before outpatient colonoscopy. Data including age, gender, health status, and indication for colonoscopy were assessed. Patients were asked whether they had heard of specific CQM, including adequate bowel preparation, cecal intubation rate, greater-than-6-min withdrawal time, and ADR; responses were yes or no. The quality measures chosen were those identified by national gastroenterology societies as the most important owing to their influence on ADR and/or colorectal cancer prevention. Patients were asked whether they researched their colonoscopist before their procedure (yes/no) and were asked to provide sources of information used. Participants rated the importance of gastroenterologists reporting their ADR to other doctors and patients. Patients were also asked to rate the importance of CQM reporting in selecting between two colonoscopists recommended by their primary care physician (PCP). In the final question, patients were asked to provide the rank order for the importance of four factors (CQM reporting, cost, ease of scheduling, and the referral recommendation of their primary doctor) on their colonoscopist selection.
The association between demographics and knowledge and perception of CQM and factors influencing patient's gastroenterologist selection were examined using the χ-test or Fisher's exact test for categorical variables and t-tests for continuous variables. Statistical analysis was performed using SAS v. 9.2 (SAS Institute, Cary, NC, USA). Multivariate logistic regression analysis, adjusting for age and sex, was used to assess characteristics associated with patients' ranking of the importance of the four factors for choice of colonoscopy. Sample size was determined based on the precision of the estimate of the outcome: proportion of patients more likely to choose a colonoscopist who reported their ADR to other doctors and patients. Assuming a proportion of 50%, a sample size of 400 provides a 95% confidence interval bound of ±5% around the estimate of the proportion.
Methods
Study Population
Adults (>18 years) presenting for outpatient screening or surveillance colonoscopy to endoscopy centers at Yale-New Haven Hospital and Yale Health Outpatient Facility (May 2011—June 2012), Griffin Hospital (February 2012—June 2012), were eligible to participate in the study. These centers represent university-affiliated and community centers serving patients from lower, middle, and upper socioeconomic strata. Study participants completed a survey before undergoing colonoscopy. Patients who were unable to provide consent and non-English speaking patients were excluded. This study was approved by the Institutional Review Board at each site.
Survey Instrument
A 15-question survey was developed to assess patients' knowledge of CQMs. The questionnaire was initially piloted on 10 subjects. The survey was structured to be completed in 7–10 min and was administered before outpatient colonoscopy. Data including age, gender, health status, and indication for colonoscopy were assessed. Patients were asked whether they had heard of specific CQM, including adequate bowel preparation, cecal intubation rate, greater-than-6-min withdrawal time, and ADR; responses were yes or no. The quality measures chosen were those identified by national gastroenterology societies as the most important owing to their influence on ADR and/or colorectal cancer prevention. Patients were asked whether they researched their colonoscopist before their procedure (yes/no) and were asked to provide sources of information used. Participants rated the importance of gastroenterologists reporting their ADR to other doctors and patients. Patients were also asked to rate the importance of CQM reporting in selecting between two colonoscopists recommended by their primary care physician (PCP). In the final question, patients were asked to provide the rank order for the importance of four factors (CQM reporting, cost, ease of scheduling, and the referral recommendation of their primary doctor) on their colonoscopist selection.
Statistical Analysis
The association between demographics and knowledge and perception of CQM and factors influencing patient's gastroenterologist selection were examined using the χ-test or Fisher's exact test for categorical variables and t-tests for continuous variables. Statistical analysis was performed using SAS v. 9.2 (SAS Institute, Cary, NC, USA). Multivariate logistic regression analysis, adjusting for age and sex, was used to assess characteristics associated with patients' ranking of the importance of the four factors for choice of colonoscopy. Sample size was determined based on the precision of the estimate of the outcome: proportion of patients more likely to choose a colonoscopist who reported their ADR to other doctors and patients. Assuming a proportion of 50%, a sample size of 400 provides a 95% confidence interval bound of ±5% around the estimate of the proportion.