RSS-Feed abonnieren
DOI: 10.1055/s-0033-1344583
Data quality of the German Screening Colonoscopy Registry
Publikationsverlauf
submitted 19. Februar 2013
accepted after revision 14. Juni 2013
Publikationsdatum:
09. September 2013 (online)
![](https://www.thieme-connect.de/media/endoscopy/201310/lookinside/thumbnails/10.1055-s-0033-1344583-1.jpg)
Background and study aims: The German screening colonoscopy program is accompanied by a central registry that records the main outcome quality indicators, namely colonoscopy completion rate, adenoma detection rate (ADR), and complication rate. The aim of the present study was to assess the quality of these registry data by comparing them with data from a prospective quality assurance study based on a self-reporting audit and patient feedback of screening colonoscopy.
Patients and methods: The completeness of registry information was analyzed by comparing it with prospective data gathered by audit and patient feedback in a previous quality assurance study (ClinicalTrials.gov registration number: NCT00860665) between October 2006 and March 2008. The main outcome parameters were colonoscopy completion rate, ADR, and complication rate. Complications were recorded in three steps in the audit study using case report forms (immediate and subsequent documentation by physicians [CRF-1 and CRF-2], and patient follow-up [CRF-3]), but were documented in the registry without differentiation.
Results: A total of 12 134 individuals (mean age 64.5 years; 47 % men) who underwent screening colonoscopy at 19 private practices in Berlin over the 18-month period were included in the audit study. Patient feedback was obtained for 90.1 %. A total of 12 150 cases had been recorded in the registry by the same private practices during the same period. Colonoscopy completion rate and ADR data were comparable in the audit study and registry (completion rate 98.2 % vs. 97.7 %; ADR 21.0 % vs. 20.5 %). However, compared with the registry data, the complication rate was 3.1-fold higher in the audit (0.46 % vs. 0.15 %; P < 0.001), and double (0.33 % vs. 0.15 %; P < 0.05) when patient feedback was not included.
Conclusions: Of the screening colonoscopy quality parameters, colonoscopy completion rate and ADR, but not complication rates, were reliably documented in the German national screening colonoscopy registry. Data on complications need to be appropriately standardized and audited in order to be used for credentialing and benchmarking purposes.
1 Deceased October 2011
-
References
- 1 Imperiale TF, Glowinski EA, Lin-Cooper C et al. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med 2008; 359: 1218-1224
- 2 Winawer SJ, Zauber AG, Ho MN et al. The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy. New Engl J Med 1993; 329: 1977-1981
- 3 Li J, Nadel MR, Poppell CF et al. Quality assessment of colonoscopy reporting: results from a statewide cancer screening program. Diagn Ther Endosc 2010; Epub 2010 Sep 28. DOI: DOI: 10.1155/2010/419796.
- 4 Patel SG, Ahnen DJ. Isn’t it time to stop talking about colonoscopy quality and start doing something about it?. Dig Dis Sci 2011; 56: 2776-2779
- 5 Lieberman DA, Faigel DO, Logan JR et al. Assessment of the quality of colonoscopy reports: results from a multicenter consortium. Gastrointest Endosc 2009; 69: 645-653
- 6 Logan JR, Lieberman DA. The use of databases and registries to enhance colonoscopy quality. Gastrointest Endosc Clin N Am 2010; 20: 717-734
- 7 Armstrong D, Hollingworth R, Macintosh D et al. Point-of-care, peer-comparator colonoscopy practice audit: The Canadian Association of Gastroenterology Quality Program – Endoscopy. Can J Gastroenterol 2011; 25: 13-20
- 8 http://www.zi-berlin.de/cms/fileadmin/images/content/PDFs_alle/Darmkrebsfrueherk_Bericht.pdf
- 9 www.healthgrades.com
- 10 http://www.tagesspiegel.de/der-klinikfuehrer-berlin-2009/1829928.html
- 11 http://www.tagesspiegel.de/berlin/praktische-hilfe/1640568.html
- 12 Adler A, Wegscheider K, Lieberman D et al. Factors determining screening colonoscopy quality. A prospective study on adenoma detection rates from 12134 examinations (Berlin Colonoscopy Project 3, BECOP-3). Gut 2013; 62: 236-241
- 13 Bretagne JF, Ponchon T. Do we need to embrace adenoma detection rate as the main quality control parameter during colonoscopy?. Endoscopy 2008; 40: 523-528
- 14 Williams JE, Le TD, Faigel DO. Polypectomy rate as a quality measure for colonoscopy. Gastrointest Endosc 2011; 73: 498-506
- 15 Kaminski MF, Regula M, Rupinski M et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
- 16 Baxter NN, Sutradhar R, Forbes SS et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140: 65-72
- 17 Ko CW, Dominitz JA, Green P et al. Accuracy of Medicare claims for identifying findings and procedures performed during colonoscopy. Gastrointest Endosc 2011; 73: 447-453
- 18 Rex DK, Petrini JL, Baron TH et al. ASGE/ACG Taskforce on Quality in Endoscopy: Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
- 19 Segnan N, Patnick S, von Karsa L eds. European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg: Publications Office of the European Union; 2010. DOI: DOI: 10.2772/1458 (printed version); DOI: 10.2772/15379 (electronic version)
- 20 de Jonge V, Sint Nicolaas J, Cahen DL for the SCoPE Consortium et al. Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice. Gastrointest Endosc 2012; 75: 98-106
- 21 Bowles CJ, Leicester R, Romaya C et al. Prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?. Gut 2004; 53: 277-283
- 22 Kelly NM, Moorehead J, Tham T. Is the ‘driving test’ a robust quality indicator of colonoscopy performance?. World J Gastrointest Endosc 2010; 2: 112-120
- 23 Shah HA, Paszat LF, Saskin R et al. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 2007; 132: 2297-2303
- 24 Wilkins T, LeClair B, Smolkin M et al. Screening colonoscopies by primary care physicians: a meta-analysis. Ann Fam Med 2009; 7: 56-62 Erratum in: Ann Fam Med 2009; 7: 181
- 25 Regula J, Rupinski M, Kraszewska E et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863-1872
- 26 Lieberman DA, Prindiville S, Weiss DG et al. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 2003; 290: 2959-2967
- 27 Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
- 28 Kanna B, Schori M, Azeez S et al. Colorectal tumors within an urban minority population in New York City. J Gen Intern Med 2007; 22: 835-840
- 29 Bretagne JF, Hamonic S, Piette C et al. Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening program based on colonoscopy after fecal occult blood testing. Gastrointest Endosc 2010; 71: 335-341
- 30 Aslinia F, Uradomo L, Steele A et al. Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital. Am J Gastroenterol 2006; 101: 721-731
- 31 Niv Y, Hazazi R, Levi Z et al. Screening colonoscopy for colorectal cancer in asymptomatic people: a meta-analysis. Dig Dis Sci 2008; 53: 3049-3054
- 32 Imperiale TF, Wagner DR, Lin CY et al. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med 2002; 346: 1781-1785
- 33 Ibanez MB, Munoz-Navas MA, Dugue JM et al. Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy. N Engl J Med 2004; 59: 634-641
- 34 Chiu HM, Wang HP, Lee YC et al. A prospective study of the frequency and the topographical distribution of colon neoplasia in asymptomatic average-risk Chinese adults as determined by colonoscopic screening. Gastrointest Endosc 2005; 61: 547-553
- 35 Schoenfeld P, Cash B, Flood A et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005; 352: 2061-2068
- 36 Strul H, Kariv R, Leshno M et al. The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40–80 years. Am J Gastroenterol 2006; 101: 255-262
- 37 Rogge JD, Elmore MF, Mahoney SJ et al. Low-cost, office-based, screening colonoscopy. Am J Gastroenterol 1994; 89: 1775-1780
- 38 Lieberman DA, Weiss DG, Bond JH et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 2000; 343: 162-168
- 39 Imperiale TF, Wagner DR, Ching Y et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000; 343: 169-174
- 40 Soon MS, Kozarek RA, Ayub K et al. Screening colonoscopy in Chinese and Western patients: a comparative study. Am J Gastroenterol 2005; 100: 2749-2755
- 41 Zubarik R, Fleischer DE, Mastropietro C et al. Prospective analysis of complications 30 days after outpatient colonoscopy. Gastrointest Endosc 1999; 50: 322-328
- 42 Bini EJ, Firoozi B, Choung RJ et al. Systematic evaluation of complications related to endoscopy in a training setting: a prospective 30-day outcomes study. Gastrointest Endosc 2003; 57: 8-16
- 43 Korman LY, Overholt BF, Box T et al. Perforation during colonoscopy in endoscopic ambulatory surgical centers. Gastrointest Endosc 2003; 58: 554-557
- 44 Levin TR, Zhao W, Conell C et al. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med 2006; 145: 880-886
- 45 Lin OS, Kozarek RA, Schembre DB et al. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA 2006; 24 295 2357-2365
- 46 Ko CW, Riffle S, Michaels L et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol 2010; 8: 166-173