Faculty Bibliography

BACKGROUND & AIMS/OBJECTIVE:Disparities in colorectal cancer (CRC) screening uptake by race/ethnicity, socioeconomic status, and geography are well documented. We sought to further characterize the relationship between sociodemographic factors and up-to-date colonoscopy use in a diverse urban center using the 2014 New York City Community Health Survey (NYCCHS). METHODS:We examined overall colonoscopy uptake by race/ethnicity-with a particular interest in Asian and Hispanic subgroups-and used weighting to represent the entire 2014 NYC adult population. We also evaluated the association between 10 sociodemographic variables (age, sex, race/ethnicity, birthplace, home language, time living in the US, education, employment, income, and borough of residence) and colonoscopy use using univariable and multivariable logistic regression models. RESULTS:Up-to-date colonoscopy uptake was 69% overall with reported differences by racial/ethnic group, ranging from 44%-45% for Mexicans and Asian Indians to 75% for Dominicans. In the multivariable regression model, colonoscopy use was associated with age greater than 65 years, Chinese language spoken at home, and not being in the labor force. Lower colonoscopy use was associated with living in the US for less than 5 years, Asian Indian language spoken at home, lower income, and residing outside of Manhattan. CONCLUSIONS:Among New Yorkers older than age 50, up-to-date colonoscopy use varied significantly by race/ethnicity, especially in Asian and Hispanic subgroups. Recent immigrants, low-income groups, and those living outside of Manhattan were significantly less likely to receive CRC screening. Targeted interventions to promote CRC screening in these underserved groups may improve overall screening uptake.

Colorectal cancer is the second leading cause of cancer death in the United States. Prospective studies demonstrate that colorectal cancer screening reduces incidence and mortality, but uptake remains suboptimal. More than a third of age-eligible Americans are not up to date on screening. There are several available screening tests, which may cause primary care providers to ponder which is the best test. This article provides an overview of the available test options and the evidence for each; a summary of major guidelines; and a comparison of the two most widely used tests, colonoscopy and fecal immunochemical testing.

Background: Patients with inflammatory bowel disease (IBD) have many unique health maintenance needs and ofen require therapy necessitating close monitoring. Gastroenterologists ofen serve as the primary care provider for these patients and therefore must be familiar with the health maintenance needs of IBD patients. In this study, we investigated whether implementing a multi-modal educational intervention could improve providers' rates of addressing healthcare maintenance measures. METHODS: A retrospective chart review was performed in 2013-2014 on 208 IBD patients to determine adherence to performance practice measures. From February-April 2016, fellows received a recurring in-service lecture and an IBD clinic note template outlining the 2011 healthcare maintenance recommendations by the American Gastroenterological Association. An iBook was also introduced, which provided a comprehensive overview of IBD practice guidelines. Retrospective chart review was then performed 1 year aferwards. For each patient, performance measures were assessed in both pre-and post-intervention notes in the following categories: vaccinations, bone health, therapy-specifc maintenance, tobacco cessation, and cancer screening. Each performance measure was given a score of 0 (not addressed), 1 (addressed), or N/A (irrelevant to subject). Te primary outcome was improvement in rates of adherence to performance measures. Te adherence rates for pre-and post-intervention groups were compared using a chi-squared test. RESULTS: A total of 208 pre-intervention clinic visits and 40 post-intervention visits were included for analysis. Afer the interventions, the rate of healthcare maintenance measures addressed overall increased from 37% to 52% (P<.001) (Figure 1). Tere were statistically signifcant improvements in addressing bone health (29% to 63%, P<.001), vaccination (33% to 47%, P<.001), and therapy-specifc measures (53% to 74%, P=.01). Tere were no statistically signifcant changes in addressing cancer screening (66% to 58%, P=.19) or smoking (23% to 30%, P=.59). CONCLUSION(S): Te use of multiple educational interventions to enhance delivery of IBD healthcare maintenance resulted in improved adherence to healthcare maintenance measures. Targeted educational programs and a multi-modal approach may be an effective method for teaching GI fellows and reinforcing the importance of addressing these measures to optimize the care of their IBD patients