Development of the Parkland-UT Southwestern Colonoscopy Reporting System (CoRS) for evidence-based colon cancer surveillance recommendations

Skinner, Celette Sugg; Gupta, Samir; Halm, Ethan A.; Wright, Shaun P.; McCallister, Katharine; Bishop, Wendy Pechero; Santini, Noel O.; Mayorga, Christian A.; Agrawal, Deepak; Moran, Brett; Sanders, Joanne M.; Singal, Amit G.

doi:10.1093/jamia/ocv081

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…Electronic medical record (EMR)-based decision support systems may be one way to improve guideline concordance of surveillance recommendations. For example, the Parkland-UT Southwestern Colonoscopy reporting system (CoRS) helps providers pair colonoscopy and biopsy findings with guideline-concordant surveillance recommendations [22]. However, studies are needed to better understand factors contributing to overuse and underuse of surveillance colonoscopy that can inform future intervention strategies to improve guideline concordance.…”

Section: Discussionmentioning

confidence: 99%

Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system

Kahn

Freeland

Gopal

et al. 2015

Cancer Causes Control

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Purpose Appropriate surveillance intervals for colorectal cancer (CRC) screening is one of the Centers for Medicare and Medicaid Services 2014 physician quality reporting system measures. Appropriateness of surveillance intervals will continue to be monitored closely, particularly as reimbursements become tied to quality measures. Aims Quantify and identify predictors for guideline-concordant surveillance recommendations after adenoma polypectomy. Methods We conducted a retrospective cohort study of patients who had colonoscopy with polypectomy at a safety-net health system between June 2011 and December 2013. Surveillance recommendations shorter and longer than guideline recommendations were defined as potential overuse and underuse. We used multivariate logistic regression to identify correlates of guideline-concordant surveillance recommendations, overuse, and underuse. Results Among 1,822 patients with polypectomy, 1,329 had ≥1 adenoma. Surveillance interval recommendations were guideline-concordant in 1,410 (77.4 %) patients, potential overuse in 263 (14.4 %), potential underuse in 85 (4.7 %), and missing in 64 (3.5 %) patients. Predictors of guideline-concordant recommendations in multivariate analyses included age >65 years (OR 1.36, 95 % CI 1.02–1.80), incomplete resection (OR 3.58, 95 % CI 1.41–9.09), and good/excellent prep quality (OR 2.22, 95 % CI 1.72–2.86). Underuse recommendations were more likely in patients with ≥3 adenomas; overuse recommendations were more likely in patients with high-grade dysplasia or fair prep quality and less likely in those with piecemeal resection, ≥3 adenomas, age>65, or Hispanic ethnicity. Conclusions Surveillance recommendations are not concordant with guidelines in one of four cases. Interventions to improve prep quality and guideline concordance of surveillance recommendations can improve cost-effectiveness of CRC screening.

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Section: Discussionmentioning

confidence: 99%

Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system

Kahn

Freeland

Gopal

et al. 2015

Cancer Causes Control

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“…As previously described, 16 CoRS is a novel EPICbased NoteWriter (PatientKeeper, Inc.) form that uses cascading questions in pull-down menus that prompt the endoscopist to report (1) cecal intubation, (2) quality of bowel preparation, (3) family his-tory of colon cancer or polyps, (4) number of polyps, and (5) "worst finding" on pathology. For example, in a patient with a large tubular adenoma and a hyperplastic polyp, the worst finding would be "1 cm or larger adenoma."…”

Section: Colonoscopy Pathology Reporting Systemmentioning

confidence: 99%

“…CoRS was designed to be easy to use and can be completed quickly by endoscopists with minimal workflow disruption. 16…”

Section: Colonoscopy Pathology Reporting Systemmentioning

confidence: 99%

“…CoRS is a userfriendly, EMR-based template that captures data from colonoscopy and pathology reports and uses a computerized algorithm to generate tailored, guideline-adherent recommendations for the next surveillance colonoscopy after polypectomy. 16 The CoRS algorithm is based on published guidelines and produces tailored reporting letters (in English and Spanish) for patients and their referring physicians. Provider acceptance and use in clinical practice exceeded 90% during the first 6 months after implementation.…”

mentioning

confidence: 99%

“…However, prior studies have shown that early provider acceptance of new interventions can decrease over time. 16 Further, the impact of CoRS on guideline adherence to surveillance recommendations was unknown.…”

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confidence: 99%

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Impact of a Clinical Decision Support System on Guideline Adherence of Surveillance Recommendations for Colonoscopy After Polypectomy

Magrath¹,

Yang²,

Ahn³

et al. 2018

J Natl Compr Canc Netw

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Background: Surveillance colonoscopy is required in patients with polyps due to an elevated colorectal cancer (CRC) risk; however, studies suggest substantial overuse and underuse of surveillance colonoscopy. The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Methods: We performed a retrospective cohort study of patients who underwent colonoscopy with polypectomy at a safety-net healthcare system before (n=1,822) and after (n=1,320) implementation of CoRS in December 2013. Recommendations were classified as guideline-adherent or nonadherent according to the US Multi-Society Task Force on CRC. We defined surveillance recommendations shorter and longer than guideline recommendations as potential overuse and underuse, respectively. We used multivariable generalized linear mixed models to identify correlates of guideline-adherent recommendations. Results: The proportion of guideline-adherent surveillance recommendations was significantly higher post-CoRS than pre-CoRS (84.6% vs 77.4%; P<.001), with fewer recommendations for potential overuse and underuse. In the post-CoRS period, CoRS was used for 89.8% of cases and, compared with cases for which it was not used, was associated with a higher proportion of guideline-adherent recommendations (87.0% vs 63.4%; RR, 1.34; 95% CI, 1.23-1.42). In multivariable analysis, surveillance recommendations were also more likely to be guideline-adherent in patients with adenomas but less likely among those with fair bowel preparation and those with family history of CRC. Of 203 nonadherent recommendations, 70.4% were considered potential overuse, 20.2% potential underuse, and 9.4% were not provided surveillance recommendations. Conclusions: An EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.Colorectal cancer (CRC) screening can reduce CRC incidence and mortality. 1 Although CRC screening can be performed using stool-based methods or colonosco-py, many US providers prefer colonoscopy because it is both diagnostic and therapeutic, permitting simultaneous removal of precancerous lesions. 2,3

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Building a Surgical Practice in a County Hospital System

Jones

AbdelFattah

2020

Building a Clinical Practice

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Development of the Parkland-UT Southwestern Colonoscopy Reporting System (CoRS) for evidence-based colon cancer surveillance recommendations

Abstract: CoRS is well-accepted by clinicians and provides guideline-based recommendations and results communications to patients and providers.

Cited by 13 publications

References 22 publications

Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system

Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system

Impact of a Clinical Decision Support System on Guideline Adherence of Surveillance Recommendations for Colonoscopy After Polypectomy

Building a Surgical Practice in a County Hospital System

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