ADR Improvement: The Result of the Intervention or the Hawthorne Effect

Sewitch, Maida; Carpentier, Stéphanie; Bessissow, Talat

doi:10.1038/ajg.2013.309

Cited by 5 publications

(5 citation statements)

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“…Furthermore, the Hawthorne effect may have occurred; endoscopists might put more effort in examining the colon than usual when they are aware that they are being monitored. 26 Although no significance difference in the total PDR was observed, the present study did show that LCI detected more polyps per patient, reflected by a significance difference in mean number of polyps per patient. Many of these polyps were adenomas and this explains why the adenoma detection rate is significantly different and PDR is not.…”

Section: Discussioncontrasting

confidence: 77%

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Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Houwen

Hazewinkel

Pellisé

et al. 2021

Gut

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ObjectiveDespite regular colonoscopy surveillance, colorectal cancers still occur in patients with Lynch syndrome. Thus, detection of all relevant precancerous lesions remains very important. The present study investigates Linked Colour imaging (LCI), an image-enhancing technique, as compared with high-definition white light endoscopy (HD-WLE) for the detection of polyps in this patient group.DesignThis prospective, randomised controlled trial was performed by 22 experienced endoscopists from eight centres in six countries. Consecutive Lynch syndrome patients ≥18 years undergoing surveillance colonoscopy were randomised (1:1) and stratified by centre for inspection with either LCI or HD-WLE. Primary outcome was the polyp detection rate (PDR).ResultsBetween January 2018 and March 2020, 357 patients were randomised and 332 patients analysed (160 LCI, 172 HD-WLE; 6 excluded due to incomplete colonoscopies and 19 due to insufficient bowel cleanliness). No significant difference was observed in PDR with LCI (44.4%; 95% CI 36.5% to 52.4%) compared with HD-WLE (36.0%; 95% CI 28.9% to 43.7%) (p=0.12). Of the secondary outcome parameters, more adenomas were found on a patient (adenoma detection rate 36.3%; vs 25.6%; p=0.04) and a colonoscopy basis (mean adenomas per colonoscopy 0.65 vs 0.42; p=0.04). The median withdrawal time was not statistically different between LCI and HD-WLE (12 vs 11 min; p=0.16).ConclusionLCI did not improve the PDR compared with HD-WLE in patients with Lynch syndrome undergoing surveillance. The relevance of findings more adenomas by LCI has to be examined further.Trial registration numberNCT03344289.

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Section: Discussioncontrasting

confidence: 77%

“…Furthermore, the Hawthorne effect may have occurred; endoscopists might put more effort in examining the colon than usual when they are aware that they are being monitored. 26 …”

Section: Discussionmentioning

confidence: 99%

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Houwen

Hazewinkel

Pellisé

et al. 2021

Gut

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“…Additionally, it is believed that not only the feedback, but also the knowledge of the endoscopist is being observed, measured, and monitored, and it can change its attitude during the colonoscopic examination and reflect on the improvement and increase of this index, a phenomenon called the Hawthorn effect 23 . As a hypothesis, as well as for the rate of cecal intubation, it was assumed that the time of experience and years after training in gastrointestinal endoscopy would have a positive impact on the detection rate of polyps.…”

Section: Discussionmentioning

confidence: 99%

Quality indicators in colonoscopy: observational study in a supplementary health system

2022

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Purpose: Colorectal cancer is responsible for 9.4% of cancer deaths, and low polyp detection rate and cecal intubation rate increase the risks of interval colorectal cancer. Despite several population studies that address colonoscopy quality measures, there is still a shortage of these studies in Latin America. The aim of this study was to assess quality indicators in colonoscopy, enabling future strategies to improve colorectal cancer prevention. Methods: An observational retrospective study, in which all colonoscopies performed in 11 hospitals were evaluated through a review of medical records. Information such as procedure indication, colorectal polyp detection rate, cecal intubation rate, quality of colonic preparation, and immediate adverse events were collected and analyzed. Results: In 17,448 colonoscopies performed by 86 endoscopists, 57.9% were in patients aged 50 to 74 years old. Colon preparation was adequate in 94.4% procedures, with rates of cecal intubation and polyp detection of 94 and 36.6%, respectively. Acute adverse events occurred in 0.2%. In 53.9%, high-definition imaging equipment was used. The procedure location, colon preparation and high-definition equipment influenced polyp detection rates (p < 0.001). Conclusions: The extraction and analysis of electronic medical records showed that there are opportunities for improvement in colonoscopy quality indicators in the participating hospitals.

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“…The process by which quality improvements occur has previously been attributed to behavioural change from the so-called Hawthorne effect,26 in which the knowledge of being observed alters the study participants’ attitude and, thus, the outcomes. While an improvement induced by observation might initially appear to be a confounding factor, it could also be considered a positive by-product of the feedback process.…”

Section: Discussionmentioning

confidence: 99%

Regular feedback to individual endoscopists is associated with improved adenoma detection rate and other key performance indicators for colonoscopy

Lim

Tritto

Zeki

et al. 2022

Frontline Gastroenterol

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ObjectiveMonitoring of key performance indicators (KPIs) is a vital element of endoscopy quality improvement. Adenoma detection rate (ADR) is considered the best marker for colonoscopic quality as it inversely correlates with subsequent colonic cancer incidence and mortality, while polyp detection rate (PDR) is an easier-to-calculate surrogate for ADR. This study assessed whether regular feedback to individual endoscopists about their KPIs improved departmental performance.MethodsIndividual KPIs were calculated for a period of 8 years (January 2012–December 2019) and fed back to all endoscopists at 6 monthly intervals, alongside anonymised indicators for other endoscopists, aggregate departmental performance data and benchmarks. An automated natural language processing software (EndoMineR) was used to identify adenomas in pathology reports and calculate ADR. Linear regressions were calculated for departmental ADR, PDR and other KPIs at 6 monthly intervals.Results39 359 colonoscopies (average 2460 in every 6-month period, range 1799–3059) were performed by an average of 42 (range 34–50) endoscopists. A continuous improvement in collective performance including ADR (12.7%–21.0%, R2 0.92, p<0.001) and PDR (19.0%–29.6%, R2 0.77, p<0.001) was observed throughout the study. Other KPIs showed similar improvement. The detection of non-neoplastic polyps did not increase. When analysed separately, ADR and PDR appeared to improve for gastroenterologists and nurse endoscopists but not for surgeons.ConclusionRegular feedback with individual and departmental KPIs was associated with improved ADR and overall performance throughout the 8-year study period. Concomitant monitoring of ADR and PDR may prevent ‘gaming’ behaviour and ensure that genuine improvement is achieved.

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ADR Improvement: The Result of the Intervention or the Hawthorne Effect

Cited by 5 publications

References 2 publications

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Quality indicators in colonoscopy: observational study in a supplementary health system

Regular feedback to individual endoscopists is associated with improved adenoma detection rate and other key performance indicators for colonoscopy

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