Post-Colonoscopy Colorectal Cancer in Alberta
Aggregate data reporting as a method for addressing quality and standards of care
Alberta Colorectal Cancer Screening Program (Alberta Health Services)
A post-colonoscopy colorectal cancer (PCCRC) is a cancer diagnosed between six months and five years after a colonoscopy reports no cancer.
Many experts, including the Canadian Association of Gastroenterology, recommend colonoscopies as the primary method for colorectal cancer screening. There are many measures of quality in the provision of colonoscopy services – one of which measures interval or missed cancer rates. Interval cancers are those not detected after a colonoscopy screening, or those that develop within the recommended time interval between colonoscopies.
This project was a partnership between the Physician Learning Program (PLP) and Alberta Health Services Alberta Colorectal Cancer Screening Program (ACRCSP). Two project objectives were identified:
Provide endoscopy units, or physicians who perform colonoscopies, with comparative provincial, zonal, facility and/or individual interval colorectal cancer rates (depending on overall numbers and local factors) as a reflection of colonoscopy quality and meeting standards of care
Determine whether colonoscopy quality and interval cancer rates are acceptable in Alberta
We focused on data for Alberta resident aged 40 years and older with a first-time diagnosis of colorectal cancer in 2013. First-time cases of colorectal cancer diagnosed in 2013 were identified through the Alberta Cancer Registry. These cases were linked to the National Ambulatory Care Reporting System, Discharge Abstract Database and Alberta Ambulatory Care Reporting System databases to determine the dates of previous colonoscopies.
First-time diagnoses of colorectal cancer in Alberta in 2013 (147 patients)
By analyzing the data, we were able to gain a better understanding of colorectal cancer frequency in Alberta and determine the PCCRC rate of healthcare providers across the province. To share this data with physicians, we created an aggregate data report that identified PCCRC locations and contributing factors. The report provided physicians with actionable steps they could take within their practice – including the ability to receive a confidential report summarizing their individualized PCCRC practice data during the study period.
Our partnership with the Alberta Colorectal Cancer Screening Program allowed us to send aggregate data reports to over 500 healthcare professionals performing colonoscopies in Alberta. Of the 500 healthcare professionals that received reports, 93 physicians registered for and received confidential, individualized data reports that summarized their practice on PCCRC during the study period.
Individualized data reports outlining comparative colorectal cancer rates in Alberta gave physicians an opportunity to recognize and address their learning needs surrounding colonoscopy quality and standards of care.