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Leveraging Electronic Health Records to Measure Low-Value Screening Colonoscopy

Published:February 24, 2022DOI:https://doi.org/10.1016/j.amjmed.2021.12.008
      Among more than 6 million screening colonoscopies performed annually in the United States, up to one-third may represent potential overuse.
      • Joseph DA
      • Meester RG
      • Zauber AG
      • et al.
      Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity.
      ,
      • Morgan DJ
      • Dhruva SS
      • Wright SM
      • Korenstein D
      2016 Update on medical overuse: a systematic review.
      Colorectal cancer (CRC) screening overuse is defined as screening in specific clinical scenarios that provide no net benefit to individuals, such as screening too frequently or outside the age of eligibility.
      • Chan KS
      • Chang E
      • Nassery N
      • et al.
      The state of overuse measurement: a critical review.
      • Parchman ML
      • Palazzo L
      • Austin BT
      • et al.
      Taking action to address medical overuse: common challenges and facilitators.
      • Johnson PT
      • Pahwa AK
      • Feldman LS
      • Ziegelstein RC
      • Hellmann DB
      Advancing high-value health care: a new AJM column dedicated to cost-conscious care quality improvement.
      Colonoscopy overuse is an important problem because it can cause direct patient harm (eg, 0.3% complication rate leading to hospitalization or death), raise health care costs, and reduce availability of appropriate endoscopy for other individuals.
      • Chan KS
      • Chang E
      • Nassery N
      • et al.
      The state of overuse measurement: a critical review.
      ,
      PDQ Screening and Prevention Editorial Board
      Colorectal cancer screening (PDQ®): Health professional version.
      ,
      • Walter LC
      • Lewis CL
      • Barton MB
      Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence.
      Minimizing inappropriate colonoscopies will expand access to high-value screening, which is particularly salient in light of new US Preventative Services Task Force (USPSTF) guidelines that recommend all individuals age 45-49 engage in CRC screening in addition to individuals ages 50-75.
      • Davidson KW
      • Barry MJ
      • Mangione CM
      • et al.
      Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
      ,
      • Ng K
      • May FP
      • Schrag D
      US Preventive Services Task Force recommendations for colorectal cancer screening: forty-five is the new fifty.
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      REFERENCES

        • Joseph DA
        • Meester RG
        • Zauber AG
        • et al.
        Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity.
        Cancer. 2016; 122: 2479-2486
        • Morgan DJ
        • Dhruva SS
        • Wright SM
        • Korenstein D
        2016 Update on medical overuse: a systematic review.
        JAMA Intern Med. 2016; 176: 1687-1692
        • Chan KS
        • Chang E
        • Nassery N
        • et al.
        The state of overuse measurement: a critical review.
        Med Care Res Rev. 2013; 70: 473-496
        • Parchman ML
        • Palazzo L
        • Austin BT
        • et al.
        Taking action to address medical overuse: common challenges and facilitators.
        Am J Med. 2020; 133: 567-572
        • Johnson PT
        • Pahwa AK
        • Feldman LS
        • Ziegelstein RC
        • Hellmann DB
        Advancing high-value health care: a new AJM column dedicated to cost-conscious care quality improvement.
        Am J Med. 2017; 130: 619-621
        • PDQ Screening and Prevention Editorial Board
        Colorectal cancer screening (PDQ®): Health professional version.
        PDQ Cancer Information Summaries. National Cancer Institute, Bethesda, MD2021 (Available at:) (Accessed January 29, 2021)
        • Walter LC
        • Lewis CL
        • Barton MB
        Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence.
        Am J Med. 2005; 118: 1078-1086
        • Davidson KW
        • Barry MJ
        • Mangione CM
        • et al.
        Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2021; 325: 1965-1977
        • Ng K
        • May FP
        • Schrag D
        US Preventive Services Task Force recommendations for colorectal cancer screening: forty-five is the new fifty.
        JAMA. 2021; 325: 1943-1945
        • Newton EH
        • Zazzera EA
        • Van Moorsel G
        • Sirovich BE
        Undermeasuring overuse–an examination of national clinical performance measures.
        JAMA Intern Med. 2015; 175: 1709-1711
        • Mafi JN
        • Reid RO
        • Baseman LH
        • et al.
        Trends in Low-value health service use and spending in the US Medicare fee-for-service program, 2014-2018.
        JAMA Netw Open. 2021; 4e2037328
        • Bian J
        • Bennett C
        • Cooper G
        • et al.
        Assessing colorectal cancer screening adherence of Medicare fee-for-service beneficiaries age 76 to 95 years.
        J Oncol Pract. 2016; 12: e670-e680
        • Saini SD
        • Powell AA
        • Dominitz JA
        • et al.
        Developing and testing an electronic measure of screening colonoscopy overuse in a large integrated healthcare system.
        J Gen Intern Med. 2016; 31: 53-60
        • Johnson MR
        • Grubber J
        • Grambow SC
        • et al.
        Physician non-adherence to colonoscopy interval guidelines in the veterans affairs healthcare system.
        Gastroenterology. 2015; 149: 938-951
        • Korenstein D
        • Falk R
        • Howell EA
        • Bishop T
        • Keyhani S
        Overuse of health care services in the United States: an understudied problem.
        Arch Intern Med. 2012; 172: 171-178
        • Murphy CC
        • Sandler RS
        • Grubber JM
        • Johnson MR
        • Fisher DA
        Underuse and overuse of colonoscopy for repeat screening and surveillance in the veterans health administration.
        Clin Gastroenterol Hepatol. 2016; 14: e431
        • Goodwin JS
        • Singh A
        • Reddy N
        • Riall TS
        • Kuo YF
        Overuse of screening colonoscopy in the Medicare population.
        Arch Intern.Med. 2011; 171: 1335-1343
        • Kruse GR
        • Khan SM
        • Zaslavsky AM
        • Ayanian JZ
        • Sequist TD
        Overuse of colonoscopy for colorectal cancer screening and surveillance.
        J Gen Intern Med. 2015; 30: 277-283
        • Mafi JN
        • May FP
        • Kahn KL
        • et al.
        Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
        J Am Geriatr Soc. 2019; 67: 2600-2604
        • Katki HA
        • Li Y
        • Edelstein DW
        • Castle PE
        Estimating the agreement and diagnostic accuracy of two diagnostic tests when one test is conducted on only a subsample of specimens.
        Stat Med. 2012; 31: 436-448
        • Harkema H
        • Chapman WW
        • Saul M
        • Dellon ES
        • Schoen RE
        • Mehrotra A
        Developing a natural language processing application for measuring the quality of colonoscopy procedures.
        J Am Med Inform Assoc. 2011; 18: i150-i156