title: Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network.
abstract: Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings.
  
  
  
  The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites.
  
  
  
  No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106).
  
  
  
  ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.
authors.affiliation: Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Holub
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Morris
authors.affiliation: Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Fagnan
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Judith R
authors.initials: JR
authors.lastname: Logan
authors.affiliation: Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.
authors.forename: LeAnn C
authors.initials: LC
authors.lastname: Michaels
authors.affiliation: Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon.
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009922:Oregon; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data
keywords: colonoscopy; primary care; quality; rural