title: Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program.
abstract: BACKGROUND
  Gaps in screening quality in community practice have been well documented. The authors examined recommended indicators of screening quality in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program (CRCSDP), which provided colorectal cancer screening and diagnostic services between 2005 and 2009 for asymptomatic, low-income, underinsured, or uninsured individuals at 5 sites around the United States.
  
  
  METHODS
  For each client screened in the CRCSDP, a standardized set of colorectal cancer clinical data elements was collected. Data regarding client age, screening history, risk level, screening test indication, results, and recommendation for the next test were analyzed. For colonoscopies, data were analyzed regarding whether the cecum was reached, bowel preparation was adequate, and identified lesions were completely removed.
  
  
  RESULTS
  Overall, 53% of the fecal occult blood tests (FOBTs) (2295 tests) distributed were completed and returned. At the 2 sites with adequate numbers of FOBTs, 77% and 97%, respectively, of clients with positive results received follow-up colonoscopies. Site-specific cecal intubation rates ranged from 90% to 98%. Adenoma detection rates were 32% for men and 21% for women. For approximately one-third of colonoscopies, the recommended interval to the next test was shorter than recommended by national guidelines. At some sites, endoscopists failed to report on the adequacy of bowel preparation and completeness of polyp removal.
  
  
  CONCLUSIONS
  Cecal intubation rates and adenoma detection rates met recommended levels. The authors identified the need for improvements in the follow-up of positive FOBTs, documentation of important elements in colonoscopy reports, and recommendations for rescreening or surveillance intervals after colonoscopy. Monitoring quality indicators is important to improve screening quality.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mrn1@cdc.gov
authors.forename: Marion R
authors.initials: MR
authors.lastname: Nadel
authors.forename: Janet
authors.initials: J
authors.lastname: Royalty
authors.forename: Jean A
authors.initials: JA
authors.lastname: Shapiro
authors.forename: Djenaba
authors.initials: D
authors.lastname: Joseph
authors.forename: Laura C
authors.initials: LC
authors.lastname: Seeff
authors.forename: Dorothy S
authors.initials: DS
authors.lastname: Lane
authors.forename: Diane M
authors.initials: DM
authors.lastname: Dwyer
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D003113:Colonoscopy / Q000379:methods / Q000592:standards; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D019984:Quality Indicators, Health Care; D014481:United States
keywords: colonoscopy; colorectal neoplasms; fecal occult blood; health care; mass screening; quality indicators