Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the XXXX .

@entity1 @entity652 @entity283 @entity14
BACKGROUND _ AIMS: Regular screening with colonoscopy lowers @entity14 incidence and mortality. We aimed to determine patterns of repeat and surveillance colonoscopy and identify factors associated with overuse and underuse of colonoscopy. METHODS: We analyzed data from @entity1 in a previous @entity283 ( @entity283 ) study who underwent outpatient colonoscopy at 25 @entity283 facilities between October 2007 and September 2008 (n  = 1455). The proportion of @entity1 who received a follow-up colonoscopy was calculated for 3 risk groups, which were defined on the basis of the index colonoscopy: no @entity652 , low-risk @entity652 , or high-risk @entity652 . RESULTS: Colonoscopy was overused (used more frequently than intervals recommended by guidelines) by 16% of @entity1 with no @entity652 , 26% with low-risk @entity652 , and 29% with high-risk @entity652 . Most @entity1 with high-risk @entity652 (54%) underwent colonoscopy after the recommended interval or did not undergo colonoscopy. @entity1 who received a follow-up recommendation that was discordant with guidelines were more likely to undergo colonoscopy too early (no @entity652 odds ratio [OR], 3.80; 95% confidence interval [CI], 2.31-6.25 and low-risk @entity652 OR, 5.28; 95% CI, 1.88-14.83). Receipt of colonoscopy at nonacademic facilities was associated with overuse among @entity1 without @entity652 (OR, 5.26; 95% CI, 1.96-14.29) or with low-risk @entity652 (OR, 3.45; 95% CI, 1.52-7.69). Performance of colonoscopies by general surgeons vs gastroenterologists (OR, 2.08; 95% CI, 1.02-4.23) and female sex of the @entity1 (OR, 3.28; 95% CI, 1.06-10.16) were associated with overuse of colonoscopy for @entity1 with low-risk @entity652 . No factors examined were associated with underuse of colonoscopy among @entity1 with high-risk @entity652 . CONCLUSIONS: In an analysis of @entity1 in the @entity283 system, more than one fourth of @entity1 with low-risk @entity652 received follow-up colonoscopies too early, whereas more than one half of those with high-risk @entity652 did not undergo surveillance colonoscopy as recommended. Our findings highlight the need for system-level improvements to facilitate the appropriate delivery of colonoscopy that is based on individual risk.
