title: A comparison of hospital and nonhospital colonoscopy: wait times, fees and guideline adherence to follow-up interval.
abstract: BACKGROUND
  Although colonoscopy is increasingly performed in nonhospital facilities, studies to date examining differences between colonoscopy services in hospital and nonhospital settings have been limited, in large part, to administrative databases.
  
  
  OBJECTIVE
  To describe the experiences of patients receiving colonoscopy in hospital and nonhospital settings, and to compare these settings with respect to wait times and recommended follow-up interval to the next colonoscopy.
  
  
  METHODS
  A postal survey of 2000 patients, 50 to 70 years of age, from an urban academic family practice was conducted. Most recent colonoscopy was classified as either occurring in a hospital or nonhospital setting. Multivariable logistic regression analysis was used to examine the association among wait times, follow-up intervals and patient factors with respect to colonoscopy setting.
  
  
  RESULTS
  Patients who underwent their most recent colonoscopy outside of a hospital were more likely to be men (P=0.01) and to have undergone more than one previous colonoscopy (P=0.02). For patients with a normal screening colonoscopy and no family history of colorectal cancer or polyps, nonhospital clinics less often recommended a 10-year follow-up interval (OR 0.13 [95% CI 0.04 to 0.47]). Reported wait times at nonhospital clinics were shorter for patients receiving screening colonoscopy (OR 2.11 [95% CI 1.28 to 3.47]), but not for symptomatic patients (OR 1.74 [95% CI 0.88 to 3.43]). For individuals attending nonhospital clinics, 10% were referred from a hospital by the same specialist performing the procedure; 31.7% reported paying a fee.
  
  
  CONCLUSIONS
  Nonhospital clinics were far less likely to adhere to guidelines regarding follow-up intervals for low-risk patients. Given the implications for both health care costs and patient safety, further study is needed to determine the cause of this disparity.
authors.affiliation: Family Practice Health Centre, Women's College Hospital, Toronto, Ontario. noah.ivers@utoronto.ca
authors.forename: Noah
authors.initials: N
authors.lastname: Ivers
authors.forename: Michael
authors.initials: M
authors.lastname: Schwandt
authors.forename: Susan
authors.initials: S
authors.lastname: Hum
authors.forename: Danielle
authors.initials: D
authors.lastname: Martin
authors.forename: Jill
authors.initials: J
authors.lastname: Tinmouth
authors.forename: Nick
authors.initials: N
authors.lastname: Pimlott
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000517:prevention & control; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D012004:Rectal Neoplasms / Q000517:prevention & control