Public reporting of colonoscopy quality is associated with an increase in endoscopist adenoma detection rate

Abstract

Background Colonoscopy is the predominant method for colorectal cancer screening in the US. Prior studies have documented variation across physicians in colonoscopy quality as measured by the adenoma detection rate (ADR). ADR is the primary quality measure of colonoscopy exams and an indicator of the likelihood of subsequent patient colorectal cancer. There is interest in mechanisms to improve ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality. Objective To assess whether this initiative was associated with an improvement in ADR. Design This study compares ADR before and after public reporting at a private practice endoscopy center of 11 gastroenterologists in Peoria, Illinois who participated in the initiative. To generate ADR, colonoscopy and pathology reports from exams performed over four years at the endoscopy center were analyzed using previously validated natural language processing software. Setting Central Illinois Endoscopy Center Results The ADR for colonoscopy in the pre-public reporting era was 25.1%, and after public reporting was 36.4% (increase of 11.3%, p<0.001). Detection of advanced adenomas increased from 10.0% to 12.7% (p<0.001). Each physician’s ADR increased (range of 4.3% to 17.4%). Similar increases in ADR were observed when the analysis was restricted to screening colonoscopy. Limitation There was no concurrent control group to assess whether the increased ADR was due to a secular trend. Conclusion A public reporting initiative on colonoscopy quality was associated with a relative forty-five percent increase in ADR and a 25% increase in advanced adenoma detection. Public reporting may be a means to improve colonoscopy quality.

Adenoma Detection Rate Evaluation and Quality of Colonoscopy in the Center-West Region of Brazil

“…Abdul-Baki et al monitored and evaluated endoscopists before and after the publication of the ADRs. They concluded that after reporting the rates, there was an increase from 4% to 17% in a subsequent ADR analysis (1) . More important than determining an acceptable ADR is to assess the progression of this rate over time.…”

Synthetic indicator of the impact of colorectal cancer screening programmes on incidence rates

“…For instance, the adenoma detection rate at colonoscopy has already been related to the risk of interval cancer and death 12 13. The perspective of a contribution of the adenoma detection rate in the medium-term and long-term impact on incidence rates opens a new area of evaluation and research, and possibly further warrants the adoption of effective strategies to improve the endoscopists’ sensitivity, such as publicly reporting feedbacks on individual performance 14 15…”

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

“…Nowadays, the number of audits in health care is growing, and colonoscopy is not exempted from that development, with reports showing a positive relationship between the public reporting of quality indicators, endoscopists' practice and associated results [8] .…”

“…For example, bowel preparation results or caecal intubation rates (CIRs) and other performance measures need to be studied and publicized. In fact, work based on public reporting of colonoscopy quality indicators appears to improve endoscopists' results and patients' trust [7,8] . The report of colonoscopy quality metrics is often dependent on electronic medical records.…”