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The U.S. Veterans Affairs (VA) hospital system has limits on allowable waiting periods for a variety of healthcare services. When those limits are exceeded, the VA contracts with outside providers; this practice has been applied widely to screening colonoscopy.
In a retrospective study performed in New England, 409 veterans who underwent screening or surveillance colonoscopy outside the VA system had a lower adenoma detection rate (ADR; 38% vs. 52%; P<0.001), lower adenomas per colonoscopy (APC; 0.7 vs. 1.4; P<0.001), and lower rate of advanced adenoma detection (13% vs. 22%; P<0.001) compared with a matched cohort of veterans undergoing colonoscopy at the VA. Results were similar regardless of non-VA site type (private vs. academic) and non…