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Introduction: Federally Qualified Health Centers (FQHC) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. Overall CRC screening participation in the United States declined during the COVID-19 pandemic and recovered by 2021; however, trends in underresourced settings are unknown., Methods: Using Uniform Data System data from 2014 to 2022, we assessed trends in FQHC CRC screening rates nationally, in California, and in Los Angeles County and determined clinic-level factors associated with recent screening rate changes. For each FQHC, we calculated the screening rate change from 2019 to 2020, 2020 to 2021, and 2020 to 2022. We used mixed-effects linear regression to determine clinic-level characteristics associated with each screening rate change., Results: Across all FQHC (n = 1,281), 7,016,181 patients were eligible for CRC screening in 2022. Across the United States and in California, median screening rates increased from 2014 to 2019, severely declined in 2020, and failed to return to prepandemic levels by 2022. Both nationally and in California, CRC screening declined most dramatically from 2019 to 2020 in FQHC serving majority Hispanic/Latino patients or a high proportion of patients experiencing homelessness. From 2020 to 2022, screening rates did not recover completely in US FQHC, with disproportionate recovery among FQHC serving majority non-Hispanic Black patients., Discussion: CRC screening rates at FQHC did not return to prepandemic levels by 2022, and recovery varied by FQHC patient characteristics. Tailored interventions addressing low and decreasing CRC screening rates in FQHC are urgently needed to mitigate worsening CRC disparities., (Copyright © 2024 by The American College of Gastroenterology.)

Diversity in medicine and the gastroenterology (GI) subspecialty is a topic warranting attention, especially in light of a number of recent incidents highlighting the persistence of racial, ethnic, and gender injustice in our nation. Insight into this topic is important insofar as the multitude of racial, ethnic, and gender backgrounds comprising the national patient population should be reflected, to the degree possible, by the providers serving it. Inclusion becomes particularly imperative because the quality of health care and health research and bridging disparities may be closely linked to adequate representation among healthcare providers. Despite the urgency of this topic, there is a paucity of data examining trends in gender and racial/ethnic diversity among medical professionals within the field of GI. In this narrative review, we examine how ethnoracial and gender representation has changed over time at critical points along the educational, training, and career pathways in GI., (Copyright © 2022 by The American College of Gastroenterology.)

This document is a focused update to the 2017 colorectal cancer (CRC) screening recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. This update is restricted to addressing the age to start and stop CRC screening in average-risk individuals and the recommended screening modalities. Although there is no literature demonstrating that CRC screening in individuals under age 50 improves health outcomes such as CRC incidence or CRC-related mortality, sufficient data support the U.S. Multi-Society Task Force to suggest average-risk CRC screening begin at age 45. This recommendation is based on the increasing disease burden among individuals under age 50, emerging data that the prevalence of advanced colorectal neoplasia in individuals ages 45 to 49 approaches rates in individuals 50 to 59, and modeling studies that demonstrate the benefits of screening outweigh the potential harms and costs. For individuals ages 76 to 85, the decision to start or continue screening should be individualized and based on prior screening history, life expectancy, CRC risk, and personal preference. Screening is not recommended after age 85., (Copyright © 2021 by The American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, and the AGA Institute.)

Colonoscopy is a safe and effective tool, but operator dependent. Room for improvement in the quality of colonoscopy is the impetus for the development and measurement of colonoscopy quality indicators and the focus of many efforts to improve colonoscopy quality indicator prevention and control in provider practices and health systems. We present the preprocedural, intraprocedural, and postprocedural quality indicators and benchmarks for colonoscopy. Every provider and practice must make a commitment to performing high-quality colonoscopy and implement and monitor quality metrics. There are a variety of tools available to assist in improving quality indicators that range from distal attachment devices to education and feedback. Although technology can help, it is not a substitute for proper technique. The commitment also requires provider feedback through audits and report cards. The impact of these efforts on patient outcomes is an important area of further research.

Objectives: Patient absenteeism for scheduled visits and procedures ("no-show") occurs frequently in healthcare systems worldwide, resulting in treatment delays and financial loss. To address this problem, we validated a predictive overbooking system that identifies patients at high risk for missing scheduled gastrointestinal endoscopy procedures ("no-shows" and cancellations), and offers their appointments to other patients on short notice., Methods: We prospectively tested a predictive overbooking system at a Veterans Administration outpatient endoscopy clinic over a 34-week period, alternating between traditional booking and predictive overbooking methods. For the latter, we assigned a no-show risk score to each scheduled patient, utilizing a previously developed logistic regression model built with electronic health record data. To compare booking methods, we measured service utilization-defined as the percentage of daily total clinic capacity occupied by patients-and length of clinic workday., Results: Compared to typical booking, predictive overbooking resulted in nearly all appointment slots being filled-2.5 slots available during control weeks vs. 0.35 slots during intervention weeks, t(161)=4.10, P=0.0001. Service utilization increased from 86% during control weeks to 100% during intervention weeks, allowing 111 additional patients to undergo procedures. Physician and staff overages were more common during intervention weeks, but less than anticipated (workday length of 7.84 h (control) vs. 8.31 h (intervention), t(161)=2.28, P=0.02)., Conclusions: Predictive overbooking may be used to maximize endoscopy scheduling. Future research should focus on adapting the model for use in primary care and specialty clinics.

Objectives: Prior reports have linked patient transmission of carbapenem-resistant Enterobacteriaceae (CRE, or "superbug") to endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP). We performed a decision analysis to measure the cost-effectiveness of four competing strategies for CRE risk management., Methods: We used decision analysis to calculate the cost-effectiveness of four approaches to reduce the risk of CRE transmission among patients presenting to the hospital for symptomatic common bile duct stones. The strategies included the following: (1) perform ERCP followed by US Food and Drug Administration (FDA)-recommended endoscope reprocessing procedures; (2) perform ERCP followed by "endoscope culture and hold"; (3) perform ERCP followed by ethylene oxide (EtO) sterilization of the endoscope; and (4) stop performing ERCP in lieu of laparoscopic cholecystectomy (LC) with common bile duct exploration (CBDE). Our outcome was incremental cost per quality-adjusted life year (QALY) gained., Results: In the base-case scenario, ERCP with FDA-recommended endoscope reprocessing was the most cost-effective strategy. Both the ERCP with culture and hold ($4,228,170/QALY) and ERCP with EtO sterilization ($50,572,348/QALY) strategies had unacceptable incremental costs per QALY gained. LC with CBDE was dominated, being both more costly and marginally less effective vs. the alternatives. In sensitivity analysis, ERCP with culture and hold became the most cost-effective approach when the pretest probability of CRE exceeded 24%., Conclusions: In institutions with a low CRE prevalence, ERCP with FDA-recommended reprocessing is the most cost-effective approach for mitigating CRE transmission risk. Only in settings with an extremely high CRE prevalence did ERCP with culture and hold become cost-effective.

Objectives: Although screening for colorectal cancer (CRC) is recommended for all adults aged 50 to 75 years in the United States, there are racial and ethnic disparities in who receives screening. Individuals lacking appropriate CRC screening cite various reasons for nonadherence, including lack of provider recommendation for screening. The purpose of this study is to evaluate the association between patient race and lack of provider recommendation for CRC screening as the primary reason for screening nonadherence., Methods: We conducted a cross-sectional observational study of individuals aged 50 to 75 years from the 2009 California Health Interview Survey who reported nonadherence to 2008 United States Preventive Service Task Force CRC screening guidelines. The outcome was self-report that the main reason for not undergoing CRC screening was lack of a physician recommendation ("non-recommendation") for screening. We performed logistic regression to determine significant predictors of non-recommendation, with particular attention to the role of race., Results: The study cohort included 5,793 unscreened subjects. Of the subjects, 19.1% reported that lack of a provider recommendation was the main reason for CRC nonscreening. African Americans (adjusted odds ratio (adj. OR) 1.46, 95% confidence interval (CI) 1.03-2.05) and English-speaking Asians (adj. OR 1.65, 95% CI 1.24-2.20) were more likely than whites to report physician non-recommendation as the main reason for lack of screening. Asian non-English speakers, however, were less likely to report physician non-recommendation (adj. OR 0.31, 95% CI 0.11-0.91)., Conclusion: Racial minorities are less likely than whites to receive a physician recommendation for CRC screening. Future research should evaluate why race appears to influence provider recommendations to pursue CRC screening; this is an important step to reduce disparities in CRC screening and lessen the burden of CRC in the United States.