KLF6 promotes adipocyte differentiation through histone deacetylase 3 (HDAC3)-dependent repression of Dlk1

Introduction: Heightened public awareness about the benefits of colon cancer screening and the recent changes in Medicare reimbursement; have led to increased demand for colonoscopy (COL).Demand for COL at Mayo Clinic Scottsdale (MCS) and other U.S. centers, has, at times, exceeded the ability to perform them.In addition, many requests do not follow current guidelines for COL.A process was developed wherein all requests for COL were reviewed by a skilled G1, PA-C and RN to reduce inappropriate referrals.Purpose: To determined(I) the effectiveness of the review process in reducing inappropriate referrals for COL; (2) if such a review process would be acceptable to referring medical providers and patients; (3) what percentage of requests were not indicated.Methods: At MCS an open access system is used to order COL.Medical providers order COL without a G1 consult.Prior to this study, all requests were accommodated.In this study, specific criteria were developed to determine the appropriateness of requests.Guidelines developed by national societies were used, as well as, predictors of co-morbidity (ASA class HI/IV) and life span.Medical records of patients awaiting COL for screening, surveillance or symptomatic indications at MCS were reviewed.Data was obtained regarding patients' age, risk factors for colon cancer, co-morbidities, prior procedures and referring medical provider.Patients were scheduled if request was appropriate.If inappropriate and procedure denied, patient and provider were notified by letter.The letter contained the recommended Iime for patient's future COL or alternate procedure, if warranted.Results: 359 patients (median age ~ 65) were reviewed.The major/ty were referred by their primary care provider (PCP), (75.8%), and, the other by specialists (15.6%GI versus 8.6% non-GI specialists).0l the total 359 COL requests reviewed, 25.6% were inappropriate (see table ).Conclusion: Although the majority of the referrals for COL were appropriate, a sigmficant number (25.6%) were inappropriate.PCPs were more likely to generate inappropriate referrals than specialists.Since resources are limited, further education in an open access system is essential to optimize judicious use of COL.