Physician Report Cards and Implementing Standards of Practice Are Both Significantly Associated With Improved Screening Colonoscopy Quality

Keswani, Rajesh N.; Yadlapati, Rena; Gleason, Kristine M.; Ciolino, Jody D.; Manka, Michael; O’Leary, Kevin J.; Barnard, Cynthia; Pandolfino, John E.

doi:10.1038/ajg.2015.103

Cited by 61 publications

(43 citation statements)

References 18 publications

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“…Such benchmark comparisons have been used successfully to improve overall performance in other areas of medicine such as colonoscopy polyp detection rates. [18][19][20] We also found a strong correlation between needle gauge and BMB length ( figure 8), a correlation that became more apparent as performers adopted this needle after seeing the results of baseline and initial follow-up data. Performers' use of an 8-gauge needle increased not due to any specific recommendations made at our discussions, but as performers viewed the data and shared their personal experiences with this larger needle among themselves.…”

Section: Discussionmentioning

confidence: 55%

“…This suggests that data sharing so individuals may compare themselves to their peers may benefit performance. Such benchmark comparisons have been used successfully to improve overall performance in other areas of medicine such as colonoscopy polyp detection rates . We also found a strong correlation between needle gauge and BMB length (figure 8), a correlation that became more apparent as performers adopted this needle after seeing the results of baseline and initial follow‐up data.…”

Section: Discussionmentioning

confidence: 61%

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Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience

Yang

Nazeef

Patel

et al. 2018

Int J Lab Hematology

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 61%

Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience

Yang

Nazeef

Patel

et al. 2018

Int J Lab Hematology

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“…Although our study is not the first to examine this intervention, it is the first to do so in a more rigorous manner. Past studies examining the effect of report cards on ADR or PDR either did not account for confounding variables 22 23 24 25 or controlled only for age and gender 26 . Given the strong association between variables such as patient age, gender, cecal intubation, and bowel preparation quality with ADR 15 16 20 , failure to adjust for these factors may lead to erroneous conclusions.…”

Section: Discussionmentioning

confidence: 99%

Performance report cards increase adenoma detection rate

et al. 2017

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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 %.

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“…The benefit of knowing our own ADR may also motivate quality improvement, as has been shown in several interventional studies with the implementation of scheduled personalized ADR report cards. Endoscopists thrive when they are aware of their own quality metrics [18,19] .…”

Section: Discussionmentioning

confidence: 99%

Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours

Ferreira

Fidalgo

Palmela

et al. 2016

GE Port J Gastroenterol

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Background: Colorectal cancer (CRC) is the first cause of cancer-related mortality in Portugal. CRC screening reduces disease-specific mortality. Colonoscopy is currently the preferred method for screening as it may contribute to the reduction of CRC incidence. This beneficial effect is strongly associated with the adenoma detection rate (ADR). Aim: Our aim was to evaluate the quality of colonoscopy at our unit by measuring the currently accepted quality parameters and publish them as benchmarking indicators. Methods: From 5,860 colonoscopies, 654 screening procedures (with and without previous fecal occult blood testing) were analyzed. Results: The mean age of the patients was 66.4 ± 7.8 years, and the gender distribution was 1:1. The overall ADR was 36% (95% confidence interval [CI] 32-39), the mean number of adenomas per colonoscopy was 0.66 (95% CI 0.56-0.77), and the sessile serrate lesion detection rate was 1% (95% CI 0-2). The bowel preparation was rated as adequate in 496 (76%) patients. The adjusted cecal intubation rate (CIR) was 93.7% (95% CI 91.7-95.8). Most colonoscopies were performed under monitored anesthesia care (53%), and 35% were unsedated. The use of sedation (propofol or midazolam based) was associated with a higher CIR with an odds ratio of 3.60 (95% CI 2.02-6.40, p < 0.001). Conclusion: Our data show an above-standard ADR. The frequency of poor bowel preparation and the low sessile serrated lesion detection rate were acknowledged, and actions were implemented to improve both indicators. Quality auditing in colonoscopy should be compulsory, and while many units may do so internally, this is the first national report from a high-throughput endoscopy unit.

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Physician Report Cards and Implementing Standards of Practice Are Both Significantly Associated With Improved Screening Colonoscopy Quality

Cited by 61 publications

References 18 publications

Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience

Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience

Performance report cards increase adenoma detection rate

Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours

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