title: Impact of an incomplete colonoscopy referral program on recommendations after incomplete colonoscopy.
abstract: BACKGROUND
  There are limited data on recommendations and adherence to complete colon evaluation (CCE) after incomplete colonoscopy (IC).
  
  
  OBJECTIVE
  Our objectives were to (1) identify recommendations and adherence to recommendations after IC, (2) determine the diagnostic yield of CCE after IC, and (3) determine the effect of an IC referral program on recommendations for CCE.
  
  
  METHODS
  We conducted a retrospective review of IC procedures at a teaching hospital over two time periods (January 1 to May 1 2004 and July 1 to November 1 2010). A referral process for repeat colonoscopy after IC was instituted in April 2009. Outcomes included (1) recommendations (2) adherence, and (3) yield of CCE after IC.
  
  
  RESULTS
  A total of 222 patients underwent at least one IC (overall rate of 2.5 %). In 120 patients (54.1 %), CCE was recommended within 1 year; the rate did not change from 2004 to 2010. Patients with IC due to poor preparation were more likely to have specific CCE recommendations (85.5 vs. 72.2 %, P = 0.03) and recommendations of endoscopic follow-up (76.3 vs. 10.4 %, P < 0.0001) than those with IC due to difficult anatomy. When IC was due to difficult colonoscopy, there was increase in endoscopic follow-up recommended (16.3 vs. 2.8 %, P = 0.01) in 2010 compared to 2004. Adherence to recommendations was similar regardless of modality recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. Polyp detection rate was greater utilizing colonoscopy than barium enema (34.3 vs. 3.6 %, P < 0.0001).
  
  
  CONCLUSIONS
  There is a lack of consensus in management strategies for patients after IC. Implementation of a referral program has had minimal impact on provider recommendations.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair, Suite 1400, Chicago, IL 60611, USA.
authors: Andrew J
authors: AJ
authors: Gawron
authors: Annapoorani
authors: A
authors: Veerappan
authors: Sean T
authors: ST
authors: McCarthy
authors: Vineel
authors: V
authors: Kankanala
authors: Rajesh N
authors: RN
authors: Keswani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002641:Chicago; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult