Quality control in a public health colorectal cancer screening program

Background: Public Health works to provide care and eliminate health disparities by providing access for low income individuals through a variety of healthcare programs. Reliable methods for assuring that the care meets established standards are essential if programs are to be effective. Information technology coupled with clinical review helps to assure quality of care. Methods: In Maryland, under Cigarette Restitution Funding, local health departments (LHDs) offer colorectal cancer screening for low-income uninsured clients. LHD staff enters client data into a secure Web-based relational database maintained on a server at the state health department (SHD). Data include demographics, risk factors (family or personal history), colonoscopy report findings including adequacy of the colonic preparation, completeness of the exam, specific findings (adenoma number, size, and histology), and recommendations for future screening procedures (recalls). Using SQL queries and clinical chart reviews, the SHD routinely analyzes data to assure program quality. Results: LHD staff entered data from 9,850 colonoscopies performed from 2001-2006. The SHD analysis detected non-standard case management practices including providers who were not biopsying polyps, were recommending recall intervals that were too short and too long compared to guidelines for post procedure surveillance, and were not rescheduling clients when the colonoscopy was inadequate. Detection of these issues led to LHD feedback to clients and endoscopists. Conclusions: Collecting data on screening procedures, establishing routine data cleaning and verification procedures, and utilizing data analysis through reports and SQL queries enables oversight of screening programs to assure the quality of care delivered in those programs.