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Grant Details

Grant Number: 5R21CA227776-02 Interpret this number
Primary Investigator: Calderwood, Audrey
Organization: Dartmouth-Hitchcock Clinic
Project Title: Reducing Inappropriate Use of Surveillance Colonoscopy in Older Adults
Fiscal Year: 2020


Project Summary  Many older adults with a history of colon polyps continue surveillance colonoscopies every 3-­5 years to  monitor for recurrent polyps, even after age 75 or when in poor health. There are no explicit guidelines for  when to stop surveillance, unlike there is for when to stop screening for colorectal cancer (CRC). Currently,  approximately 3 million surveillance colonoscopies are performed annually in the US. This number will  double to almost 6 million in the next 6 years as the population ages, rates of CRC screening increase, and  polyp detection improves. At present, there are critical knowledge gaps that hinder the development of  effective strategies to optimize surveillance use in older adults. Most critically, the magnitude of overuse of  surveillance in this aging population has not been fully quantified, nor have the factors that influence patient  and provider decision-­making. Therefore, the objective of this study is to create a detailed characterization  of surveillance colonoscopy practice in older adults and to identify current practices and medical decision  making around surveillance. We will capitalize on the unique, NCI-­funded longitudinal registry specifically  designed for colonoscopy, the New Hampshire Colonoscopy Registry (NHCR). NHCR prospectively collects  data on nearly 100% of colonoscopies performed in NH and includes detailed colonoscopy information (e.g.  indication, findings, pathology, and endoscopist follow-­up recommendations). Specifically, we will link  patients in NHCR to Medicare claims data in order to perform a detailed assessment of the use of  surveillance by life expectancy, identify patients most and least likely to benefit from surveillance based on  surveillance findings and life expectancy, and evaluate provider recommendations for next surveillance  among older adults. We will also conduct semi-­structured interviews with patients, gastroenterologists and  primary care providers to identify the multi-­level factors involved in the surveillance decision-­making  process. At the study conclusion, we will have a detailed understanding of the current practice of  surveillance colonoscopy in older adults with estimates of important clinical outcomes stratified by life  expectancy. Next steps include research to develop and validate multi-­level interventions to reduce  inappropriate surveillance colonoscopy use. Our overall goal is to maximize high value care among older  adults while minimizing risks.    


Practice Patterns and Predictors of Stopping Colonoscopy in Older Adults With Colorectal Polyps.
Authors: Rege S. , Coburn E. , Robertson D.J. , Calderwood A.H. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2022 May; 20(5), p. e1050-e1060.
EPub date: 2021-06-30.
PMID: 34216826
Related Citations

Colonoscopy utilization and outcomes in older adults: Data from the New Hampshire Colonoscopy Registry.
Authors: Calderwood A.H. , Tosteson T.D. , Walter L.C. , Hua P. , Onega T. .
Source: Journal of the American Geriatrics Society, 2022 Mar; 70(3), p. 801-811.
EPub date: 2021-12-03.
PMID: 34859887
Related Citations

Representation by Gender of Recognition Award Recipients from Gastroenterology and Hepatology Professional Societies.
Authors: Calderwood A.H. , Roberts J.A. , Silver J.K. , Schmitt C.M. , Enestvedt B.K. .
Source: Journal of women's health (2002), 2021 Oct; 30(10), p. 1508-1518.
EPub date: 2021-01-12.
PMID: 33434440
Related Citations

Impact of Knowledge and Risk Perceptions on Older Adults' Intention for Surveillance Colonoscopy.
Authors: Calderwood A.H. , Carter C. , Durand M.A. , O'Connor S. , Boardman M. .
Source: Journal of clinical gastroenterology, 2021-07-01; 55(6), p. 528-533.
PMID: 32740100
Related Citations

Screening History and Comorbidities Help Refine Stop Ages for Colorectal Cancer Screening.
Authors: Calderwood A.H. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2021 Mar; 19(3), p. 448-450.
EPub date: 2020-07-18.
PMID: 32693048
Related Citations

Impact of the COVID-19 Pandemic on Utilization of EGD and Colonoscopy in the United States: An Analysis of the GIQuIC Registry.
Authors: Calderwood A.H. , Calderwood M.S. , Williams J.L. , Dominitz J.A. .
Source: Techniques and innovations in gastrointestinal endoscopy, 2021; 23(4), p. 313-321.
EPub date: 2021-07-30.
PMID: 34345871
Related Citations

Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults.
Authors: Maratt J.K. , Calderwood A.H. .
Source: Current treatment options in gastroenterology, 2019 Jun; 17(2), p. 292-302.
PMID: 30969399
Related Citations

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