• Gretchen C Edwards, Kristy K Broman, Richard L Martin, Walter E Smalley, LeaAnne Smith, Rebecca A Snyder, Carmen C Solórzano, Robert S Dittus, and Christianne L Roumie.
• Departments of Surgery, Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, TN; Geriatric Research and Education Clinical Center, Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, TN; Departments of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: Gretchen.C.Edwards@vumc.org.
• J. Am. Coll. Surg. 2020 Aug 1; 231 (2): 257-266.

BackgroundAlthough endoscopy is recommended at 1 year after colorectal cancer (CRC) resection to detect locally recurrent CRC, earlier work at our Veterans Affairs (VA) facility demonstrated that 35% of patients achieve this metric.Study DesignThe interdisciplinary team used quality improvement methods to standardize processes and implement a gastroenterology-managed virtual surveillance clinic. The intervention clinic was implemented in August 2014. Veterans who underwent resection for stage I to III CRC at a single VA facility from January 2010 to December 2017 were included, with those undergoing resection between January 2010 and July 2014 considered pre-intervention and those undergoing resection between August 2014 and December 2017 considered post-intervention. The primary endpoint was the proportion of eligible patients for whom endoscopy was completed within 1 year of resection. Secondary outcomes were the proportion of patients who completed endoscopy within 18 months of resection or at any time post-resection and time to surveillance endoscopy.ResultsA total of 186 patients underwent resection for stage I to III CRC from 2010 to 2017; of these, 160 (86%) were eligible for endoscopy at 1-year post-resection (98 pre-intervention and 62 post-intervention). In the pre-intervention period, 30 of 98 patients (30.6%) underwent surveillance endoscopy within 1 year vs 31 of 62 (50.0%) post-intervention (p = 0.031). When evaluated at 18 months after resection, 56 of 98 patients (57.1%) in the pre-intervention group vs 52 of 62 (83.9%) in the post-intervention group underwent surveillance endoscopy (p = 0.001). Median time from resection to endoscopy decreased during the study period, from 1.19 years pre-intervention (interquartile range 0.93 to 1.74 years) to 1.0 years post-intervention (interquartile range 0.93 to 1.09 years) (p = 0.006).ConclusionsImplementation of a virtual surveillance clinic with standardized processes was associated with increased guideline-concordant endoscopic surveillance after CRC resection.Published by Elsevier Inc.

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