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Role of medico-administrative database in the selection of the target population in colorectal cancer screening
Akoï Koïvogui1,2, Robert Benamouzig3, Christian Balamou4
1Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé, Sorbonne Université, INSERM, Bobigny 93000, France.
Insights
Colorectal cancer screening programs struggle with consistent patient targeting due to varied medical exclusion criteria. Medico-administrative databases (MADB) show potential but lack standardization, hindering effective screening campaigns.
Area of Science:
- Public Health
- Cancer Epidemiology
- Health Informatics
Background:
- Colorectal cancer screening programs (CRCSP) require precise population targeting using medical information.
- Variations in medical exclusion practices complicate the identification of eligible individuals for CRCSP.
Purpose of the Study:
- To assess the consensus level in medical exclusion practices within CRCSPs globally.
- To evaluate the role and standardization of medico-administrative databases (MADB) in targeting eligible populations for CRCSP.
Main Methods:
- A descriptive study combining a cross-sectional survey of CRCSPs worldwide and a non-systematic literature review.
- Survey collected data on the use of MADB for identifying consensus-based exclusion criteria (>50% agreement).
- Assessed the availability and comparability of exclusion criteria definitions within MADBs.
Main Results:
- Twenty of 31 surveyed CRCSPs implemented medical exclusions, identifying five consensus criteria: personal history of CRC, inflammatory bowel disease, adenoma, recent colonoscopy, and genetic risk.
- Definitions of these criteria were not uniform across MADBs, impacting comparability (e.g., CRC ICD-10 codes varied).
- MADB accessibility and standardization issues were noted in several countries, limiting their effective use for screening campaigns.
Conclusions:
- Limited, less nuanced consensus criteria are used due to ease of collection.
- Non-standardized MADB use and accessibility hinder effective and comparable CRCSP targeting.
- Standardization of criteria requires addressing systemic organizational failures within CRCSPs.
Background:
Colorectal cancer (CRC) screening in average-risk populations requires filtering a target population based on medical information in population-based CRC screening programs (CRCSP). This study describes the level of consensus in medical exclusion practice and the role of the medico-administrative databases (MADB) in accurately targeting the eligible individuals for CRCSP screening campaigns.
Design:
The descriptive study combined a cross-sectional survey and a non-systematic literature review.
Methods:
A cross-sectional survey was conducted among CRCSPs worldwide. Information was collected on the use of MADB for identifying consensus-based exclusion criteria (applied by >50% of CRCSPs). When a MADB was used, the study assessed whether the definition (code lists, medical terminologies) of the exclusion criteria was available. These definitions were compared between programs to evaluate the degree of consensus.
Results:
In all, 20 out of the 31 CRCSPs (Australia, England, Manitoba, Ontario, Washington State, 26 European countries) participating in the survey implemented medical exclusions. Five consensus-based exclusion criteria were identified (personal history of CRC, inflammatory bowel disease, adenoma, recent colonoscopy, genetic risk). However, these criteria were not uniformly defined in MADBs (i.e., CRC phenotype includes ICD-10 codes C18-C21 in Catalonia, while the C21 code was excluded elsewhere). Furthermore, although the MADBs exist and contain relevant information, they remain inaccessible to screening management structures in some countries (e.g., in France).
Conclusion:
The number of consensus-based criteria was limited, and they were the least nuanced, likely because they are easier to collect using the current CRCSPs management resources. These consensual criteria can be queried in most MADBs. However, the use of MADBs was not standardized across programs for various reasons (absence of a database, unavailability of information in the database when it exists, inaccessibility of the database when it exists), limiting comparability between them. Standardizing the five consensus criteria across all programs would only be effective if the disparity caused by systemic failures in the organization of each program was controlled.
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