Adoption of CT Colonography by US Hospitals

Purpose: Computed tomographic colonography (CTC) is a new noninvasive technology proposed as an option for colorectal cancer screening. The purpose of this study was to identify the percentage of US hospitals that offered CTC between 2005 and 2008 and factors that motivated or impeded adoption. Methods: Data on the provision of colorectal cancer screening services by nonfederal, general hospitals were analyzed using the 2005 to 2008 American Hospital Association annual surveys. Additionally, in 2009, exploratory interviews were conducted with representatives from radiology departments at 9 hospitals; 6 that provided CTC and 3 that did not. Results: In 2008, 17% of hospitals offered CTC, up from 13% in 2005. Sixty-nine percent of hospitals that offered CTC in 2008 also offered optical colonoscopy services. Factors motivating the adoption of CTC included a desire to provide an alternative screening option for frail, elderly patients and patients with failed optical colonoscopy; long waits for optical colonoscopy; and promising evidence on CTC published in peer-reviewed literature. Lack of reimbursetnent was a commonly cited barrier. Conclusions: Growth of CT colonographic services at US hospitals occurred even in the absence of Medicare coverage or agreement among national guideline-setting organizations regarding CTC's use in screening. Almost one-third of hospitals that offer CTC do not offer optical colonoscopy and may not be prepared to provide adequate follow-up for patients with failed CTC.