Clinical care pathway program versus open-access system: a study on appropriateness, quality, and efficiency in the delivery of colonoscopy in the colorectal cancer

• Published in: Internal and emergency medicine 2021-08, Vol.16 (5), p.1197-1206
• Main Authors: Del Vecchio Blanco, Giovanna, Dwairi, Rami, Giannelli, Mario, Palmieri, Giampiero, Formica, Vincenzo, Portarena, Ilaria, Grasso, Enrico, Di Iorio, Laura, Benassi, Michela, Giudice, Emilia Anna, Nardecchia, Antonella, Rossi, Piero, Roselli, Mario, Sica, Giuseppe, Monteleone, Giovanni, Paoluzi, Omero Alessandro
• Format: Article
• Language: English
• Subjects: Colonoscopy; Colorectal cancer; Colorectal carcinoma; Gastroenterology; Im - Original; Internal Medicine; Medicine; Medicine & Public Health; Open access
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-020-02565-z

Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the OAC group (99%, 99%, and 86%, respectively). Waiting time in the CCP group was shorter than in the OAC group (3.88 ± 2.27 vs. 32 ± 22.31 weeks, respectively). Appropriateness of colonoscopy prescription was better in the CCP group than in the OAC group (92 vs. 50%, respectively). OAC is affected by the lack of timeliness and low appropriateness of prescription. A CCP reduces the number of inappropriate colonoscopies, especially for post-polypectomy surveillance, and improves the delivery of colonoscopy in patients requiring a fast-track examination. The high rate of inappropriate OAC suggests that this modality of healthcare should be widely reviewed.