title: Quality and safety of screening colonoscopies performed by primary care physicians with standby specialist support.
abstract: BACKGROUND
  Expanding the population's access to colonoscopy screening can reduce colorectal cancer disparities. Innovative strategies are needed to address the prevailing 50% colonoscopy screening gap, partly attributable to inadequate specialist workforce. This study examined the quality of colonoscopies by primary care physicians (PCPs) with standby specialist support at a licensed ambulatory surgery center.
  
  
  METHODS
  Retrospective data on 10,958 consecutive colonoscopies performed by 51 PCPs on 9815 patients from October 2002 to November 2007 were used to calculate the rates of cecal intubation, detection of polyps, adenomas, advanced neoplasia and cancer, adverse events, and time taken for endoscope insertion and withdrawal. The center's protocol requires a 2-person technique (using a trained technician), polyp search and removal during both scope insertion and withdrawal, and onsite expert always available for rescue assistance (either navigational or therapeutic).
  
  
  RESULTS
  Mean patient age was 58.3 (+/-10.9) years, 48.0% were male, and 48.1% African-American. The cecal intubation rate was 98.1%, polyp detection rate 63.1%, hyperplastic polyp 27.5%, adenoma 29.9%, advanced neoplasia 5.7%, cancer 0.63%, major adverse events 0.06% (including 2 perforations; no death). Mean insertion and withdrawal times were 14.4 (+/-9.3) and 10.9 (+/-6.8) minutes, respectively; 13.2 (+/-8.6) and 8.0 (+/-4.5) minutes without polyps found, and 15.1 (+/-9.6) and 12.5 (+/-7.3) minutes when > or =1 polyp was found.
  
  
  CONCLUSIONS
  In the largest published study of PCP-performed colonoscopies with standby specialist support, we observed performance quality indicators and lesion detection rates that are comparable to documented rates for experienced gastroenterologists. Systems that use PCPs with specialist backup support enable high-quality colonoscopy performance by PCPs.
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. sxirasagar@sc.edu
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hurley
authors.forename: Lekhena
authors.initials: L
authors.lastname: Sros
authors.forename: James R
authors.initials: JR
authors.lastname: Hebert
mesh_terms: D003113:Colonoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011787:Quality of Health Care; D012189:Retrospective Studies; D012449:Safety; D013022:South Carolina; D013531:Surgicenters