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Canadian Journal of Gastroenterology
Volume 24, Issue 7, Pages 419-424
Original Article

Factors Associated with Colonoscopy Performed in Nonhospital Settings

Othman Alharbi,1 Linda Rabeneck,2 Lawrence F Paszat,3 Duminda N Wijeysundera,4 Rinku Sutradhar,5 Lingsong Yun,5 Christopher M Vinden,6 and Jill Tinmouth2

1Department of Medicine, Division of Gastroenterology, Canada
2Department of Medicine, Division of Gastroenterology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Canada
3Department of Radiation Oncology, Sunnybrook Health Sciences Centre Institute for Clinical Evaluative Sciences, Canada
4Department of Anesthesia, University Health Network Institute for Clinical Evaluative Sciences University of Toronto, Canada
5Institute for Clinical Evaluative Sciences, Toronto, Canada
6Department of Surgery, University of Western Ontario, London, Ontario, Canada

Accepted 11 January 2010

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.

OBJECTIVES: To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.

METHODS: The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.

RESULTS: An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).

CONCLUSION: Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.