Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(07): E675-E682
DOI: 10.1055/s-0043-110568
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Performance report cards increase adenoma detection rate

Michael Sai Lai Sey
1   Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
,
Andy Liu
2   Department of Medicine, Western University, London, Ontario, Canada
,
Samuel Asfaha
1   Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
3   Lawson Health Research Institute, London, Ontario, Canada
,
Victoria Siebring
4   South West Regional Cancer Program, Cancer Care Ontario, Ontario, Canada
,
Vipul Jairath
1   Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
5   Robarts Clinical Trials, London, Ontario, Canada
,
Brian Yan
1   Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
› Author Affiliations
Further Information

Publication History

submitted 18 November 2016

accepted after revision 10 April 2017

Publication Date:
06 July 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims Adenoma detection rate (ADR) is an important measure of colonoscopy quality, as are polyp, advanced ADR, and adenocarcinoma detection rates. We investigated whether performance report cards improved these outcome measures.

Patients and methods Endoscopists were given report cards comparing their detection rates to the institutional mean on an annual basis. Detection rates were evaluated at baseline, 1 year after report cards (Year 1), and 2 years after report cards (Year 2). Endoscopists were unaware of the study and received no other interventions. The primary outcome was ADR and secondary outcomes were polyp detection rate (PDR), advanced ADR, and adenocarcinoma detection rate. Multivariate regression was performed to adjust for temporal trends in patient, endoscopists, and procedural factors.

Results Seventeen physicians performed 3,118 screening colonoscopies in patients with positive FOBT or family history of colon cancer. The ADR increased from 34.5 % (baseline) to 39.4 % (Year 1) and 41.2 % (Year 2) (P = 0.0037). The PDR increased from 45 % (baseline) to 48.8 % (Year 1) and 51.8 % (Year 2) (P = 0.011). There was no significant improvement in advanced ADR or adenocarcinoma detection rates. On multivariate analysis, the ADR increased by 22 % in Year 1 (P = 0.03) and 30 % in Year 2 (P = 0.008). Among physicians with a baseline ADR < 25 %, improvement in ADR was even greater, increasing 2.2 times by the end of the study (P = 0.004). Improvements in ADR were not correlated with specialty although gastroenterologists were 52 % more likely to find an adenoma than general surgeons.

Conclusions Annual performance report cards increased adenoma detection rates, especially among physicians with low ADR < 25 %.

 

  • References

  • 1 Howlader NNA, Krapcho M, Miller D. et al. (ed). SEER Cancer Statistics Review, 1975–2013. Bethesda, MD: National Cancer Institute;
    Google Scholar
  • 2 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10
    CrossrefPubMedGoogle Scholar
  • 3 Winawer SJ, Zauber AG, Ho MN. The National Polyp Study Workgroup. et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 1993; 329: 1977-1981
    CrossrefPubMedGoogle Scholar
  • 4 Zauber AG, Winawer SJ, O'Brien MJ. Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths. N Engl J Med 2012; 366: 687-696
    CrossrefPubMedGoogle Scholar
  • 5 Baxter NN, Goldwasser MA, Paszat LF. et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009; 150: 1-8
    CrossrefPubMedGoogle Scholar
  • 6 Cotterchio M, Manno M, Klar N. et al. Colorectal screening is associated with reduced colorectal cancer risk: a case-control study within the population-based Ontario Familial Colorectal Cancer Registry. Cancer Causes Control 2005; 16: 865-875
    CrossrefPubMedGoogle Scholar
  • 7 Brenner H, Chang-Claude J, Jansen L. et al. Reduced risk of colorectal cancer up to 10 years after screening, surveillance, or diagnostic colonoscopy. Gastroenterology 2014; 146: 709-717
    CrossrefPubMedGoogle Scholar
  • 8 Kahi CJ, Imperiale TF, Juliar BE. et al. Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol 2009; 7: 770-775 ; quiz 711
    CrossrefPubMedGoogle Scholar
  • 9 Manser CN, Bachmann LM, Brunner J. et al. Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest Endosc 2012; 76: 110-117
    CrossrefPubMedGoogle Scholar
  • 10 Doubeni CA, Weinmann S, Adams K. et al. Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Intern Med 2013; 158: 312-320
    CrossrefPubMedGoogle Scholar
  • 11 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
    CrossrefPubMedGoogle Scholar
  • 12 Dominic OG, McGarrity T, Dignan M. et al. American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008. Am J Gastroenterol 2009; 104: 2626-2627 ; author reply 2628-2629
    CrossrefPubMedGoogle Scholar
  • 13 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedGoogle Scholar
  • 14 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
    CrossrefPubMedGoogle Scholar
  • 15 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110: 72-90
    CrossrefPubMedGoogle Scholar
  • 16 Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 2007; 102: 856-861
    CrossrefPubMedGoogle Scholar
  • 17 Shaukat A, Oancea C, Bond JH. et al. Variation in detection of adenomas and polyps by colonoscopy and change over time with a performance improvement program. Clin Gastroenterol Hepatol 2009; 7: 1335-1340
    CrossrefPubMedGoogle Scholar
  • 18 Corley DA, Jensen CD, Marks AR. Can we improve adenoma detection rates? A systematic review of intervention studies. Gastrointest Endosc 2011; 74: 656-665
    CrossrefPubMedGoogle Scholar
  • 19 Bender R, Lange S. Adjusting for multiple testing--when and how?. J Clin Epidemiol 2001; 54: 343-349
    CrossrefPubMedGoogle Scholar
  • 20 Saltzman JR, Cash BD, Pasha SF. et al. Bowel preparation before colonoscopy. Gastrointest Endosc 2015; 81: 781-794
    CrossrefPubMedGoogle Scholar
  • 21 Brenner H, Chang-Claude J, Seiler CM. et al. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011; 154: 22-30
    CrossrefPubMedGoogle Scholar
  • 22 Lin OS, Kozarek RA, Arai A. et al. The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores. Gastrointest Endosc 2010; 71: 1253-1259
    CrossrefPubMedGoogle Scholar
  • 23 Keswani RN, Yadlapati R, Gleason KM. et al. Physician report cards and implementing standards of practice are both significantly associated with improved screening colonoscopy quality. Am J Gastroenterol 2015; 110: 1134-1139
    CrossrefPubMedGoogle Scholar
  • 24 Abdul-Baki H, Schoen RE, Dean K. et al. Public reporting of colonoscopy quality is associated with an increase in endoscopist adenoma detection rate. Gastrointest Endosc 2015; 82: 676-682
    CrossrefPubMedGoogle Scholar
  • 25 Imperiali G, Minoli G, Meucci GM. et al. Effectiveness of a continuous quality improvement program on colonoscopy practice. Endoscopy 2007; 39: 314-318
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Kahi CJ, Ballard D, Shah AS. et al. Impact of a quarterly report card on colonoscopy quality measures. Gastrointest Endosc 2013; 77: 925-931
    CrossrefPubMedGoogle Scholar
  • 27 Kaminski MF, Anderson J, Valori R. et al. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut 2016; 65: 616-624
    CrossrefPubMedGoogle Scholar
  • 28 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
    CrossrefPubMedGoogle Scholar
  • 29 Bressler B, Paszat LF, Chen Z. et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
    CrossrefPubMedGoogle Scholar
  • 30 Rabeneck L, Paszat LF, Saskin R. Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy. Clin Gastroenterol Hepatol 2010; 8: 275-279
    CrossrefPubMedGoogle Scholar
  • 31 Singh H, Nugent Z, Demers AA. et al. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol 2010; 105: 2588-2596
    CrossrefPubMedGoogle Scholar