Polyp detection during colonoscopy: the impact of rurality and physician specialty

Authors: Sercy E, Josey M, Schootman M, Probst JC, Eberth JM

Category: Cancer Health Disparities, Early Detection & Risk Prediction
Conference Year: 2018

Abstract Body:
Purpose: Polyp detection rates (PDRs) have been used to examine colonoscopy quality and risk of colorectal cancer (CRC) across patient and physician subgroups. Patients with CRC living in rural areas have lower survival rates than those in urban areas, potentially because of lack of access to quality colonoscopy services. Facility location is associated with the availability of specialists that perform colonoscopy, but patients may not visit a facility within their own residential area. Because patient residence, facility location, and physician specialty may all contribute to urban/rural disparities in colonoscopy quality, we examined PDRs across these three factors. Methods: We calculated PDRs according to patient and facility urban/rural status and physician specialty using 2010-2014 data from the South Carolina Ambulatory Discharge database on colonoscopies performed on individuals aged 50-74. Gastroenterologists and colon and rectal surgeons were classified as specialists, and other medical specialties were classified as non-specialists. Urban/rural designation was based on county Rural Urban Continuum Codes. Results: The overall PDR in the study population was 56%. Analyses indicate that PDRs were higher among urban patients (56% vs 54% for rural), colonoscopies performed in urban facilities (57% vs 51% for rural), and colonoscopies performed by specialists (59% vs 50% for non-specialists). Regardless of the rural/urban status of the patient and clinic location, specialists consistently showed higher PDRs (range 51-61%) than non-specialists (range 38-51%). In addition, colonoscopies performed at urban facilities generally had higher PDRs (range 51-61%) than those performed at rural facilities (range 38-56%), both among specialists and non-specialists. Conclusions: Higher PDRs among specialists and facilities located in urban areas (regardless of the specialty of physicians working at that facility) may reflect higher volumes and procedure quality and/or a greater proportion of high-risk patients. Additional research is planned to understand the independent and synergistic contributions of patient residence, facility location, and physician specialty on individual colonoscopy outcomes, adjusted for known correlates such as age, race/ethnicity, and gender.

Keywords: colonic polyp, colonoscopy, rural health, access to care