Delivering colonoscopy screening for low-income populations in Suffolk County

Strategies, outcomes, and benchmarks

Authors

  • Dorothy S. Lane MD, MPH,

    Corresponding author
    1. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
    • Corresponding author: Dorothy S. Lane, MD, MPH, Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY 11794-8036; Fax: (631) 444-2202; dorothy.lane@stonybrook.edu

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  • Catherine R. Messina PhD,

    1. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
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  • Mary F. Cavanagh MD, MPH,

    1. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
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  • Joseph C. Anderson MD

    1. Department of Gastroenterology and Hepatology, Stony Brook University Medical Center, Stony Brook, New York
    Current affiliation:
    1. Department of Veterans Affairs Medical Center White River Junction, VT, White River Junction, VT
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  • The articles in this supplement were commissioned based on participation in evaluating the Centers for Disease Control and Prevention-funded Colorectal Cancer Screening Demonstration Program.

  • We also thank all the collaborators of the Stony Brook University Medical Center SCOPE (Suffolk County Preventive Endoscopy) Project, who are listed elsewhere in this supplement.

  • The opinions or views expressed in this supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the journal editors, the American Cancer Society, John Wiley & Sons Inc, or the Centers for Disease Control and Prevention.

Abstract

BACKGROUND

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low-income populations to meet anticipated increasing demands.

METHODS

Project SCOPE, based in the Department of Preventive Medicine, featured internal collaboration with the academic medical center's large gastroenterology practice and external collaboration with the Suffolk County Department of Health Services' network of community health centers. Colonoscopies were performed by faculty gastroenterologists or supervised fellows. Measures of colonoscopy performance were compared with quality indicators and differences between faculty and supervised fellows were identified.

RESULTS

During a 40-month screening period, 800 initial colonoscopies were performed. Approximately 21% of women screened were found to have adenomatous polyps compared with 36% of men. Five cancers were detected. The majority of the population screened (70%) were members of minority populations. African American individuals had a higher percentage of proximally located adenomas (78%) compared with white individuals (65%) and Hispanics (49%), based on the location of the most advanced lesion. Hispanic individuals had a 36% lower risk of adenomas compared with white individuals. Performance measures including the percentage of procedures with adequate bowel preparation, cecum reached, scope withdrawal time, and adenoma detection rate met quality benchmarks when performed by either faculty or supervised fellows.

CONCLUSIONS

Project SCOPE's operational strategies demonstrated a feasible method for an academic medical center to provide high-quality screening colonoscopy for low-income populations. Cancer 2013;119(15 suppl):2842–8. © 2013 American Cancer Society.

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