title: Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina.
abstract: This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50-64 years (45-64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45-49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites.
authors.affiliation: Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA.
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.affiliation: Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA.
authors.forename: Yi-Jhen
authors.initials: YJ
authors.lastname: Li
authors.affiliation: South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA ; Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA ; WJB Dorn Department of Veterans Affairs Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209-1639, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Burch
authors.affiliation: Division of Cancer Prevention and Control, South Carolina Department of Health and Environmental Control, 2100 Bull Street, Columbia, SC 29201, USA.
authors.forename: Virginie G
authors.initials: VG
authors.lastname: Daguisé
authors.affiliation: South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hurley
authors.affiliation: South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA ; Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC 29208, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert