The National Endoscopy Database (NED) Automated Performance Reports to Improve Quality Outcomes Trial (APRIQOT) randomized controlled trial design

Abstract

Background and study aims Colonoscopists with low polyp detection have higher post colonoscopy colorectal cancer incidence and mortality rates. The United Kingdom’s National Endoscopy Database (NED) automatically captures patient level data in real time and provides endoscopy key performance indicators (KPI) at a national, endoscopy center, and individual level. Using an electronic behavior change intervention, the primary objective of this study is to assess if automated feedback of endoscopist and endoscopy center-level optimal procedure-adjusted detection KPI (opadKPI) improves polyp detection performance. Methods This multicenter, prospective, cluster-randomized controlled trial is randomizing NHS endoscopy centres to either intervention or control. The intervention is targeted at independent colonoscopists and each center’s endoscopy lead. The intervention reports are evidence-based from endoscopist qualitative interviews and informed by psychological theories of behavior. NED automatically creates monthly reports providing an opadKPI, using mean number of polyps, and an action plan. The primary outcome is opadKPI comparing endoscopists in intervention and control centers at 9 months. Secondary outcomes include other KPI and proximal detection measures at 9 and 12 months. A nested histological validation study will correlate opadKPI to adenoma detection rate at the center level. A cost-effectiveness and budget impact analysis will be undertaken. Conclusion If the intervention is efficacious and cost-effective, we will showcase the potential of this learning health system, which can be implemented at local and national levels to improve colonoscopy quality, and demonstrate that an automated system that collects, analyses, and disseminates real-time clinical data can deliver evidence- and theory-informed feedback.

Using a dark logic model to explore adverse effects in audit and feedback: a qualitative study of gaming in colonoscopy.

“…A colonoscopy BCI with task-motivation plans and supplemental educational material are being tested in the NED APRIQOT study. [20] An A&F intervention aimed at improving leadership training in centre leads demonstrated improved colonoscopy performance centre wide [49]. Our study demonstrated that where there is underperformance in behaviours related to meta-tasks, such as poor completion rates due to endoscopist con dence, then addressing this is a complex social task.…”

“…Six English NHS endoscopy centres eligible for the NED-APRIQOT study were contacted by email, selected with convenience sampling for participants' availability. Eligible endoscopists [20] were purposively sampled with criteria comprising length of endoscopy experience and professional role (clinical lead, clinical-nurse endoscopist, gastroenterologist, surgeon, and trainee). Recruitment continued until sampling strata were lled and data saturation was reached, de ned as no new themes arising in the last three interviews after 10 complete interviews.…”

“…As part of the preliminary Delphi process in NED-APRIQOT a proximal polypectomy rate in conjunction with traditional polyp detection KPI was considered by participants to promote the removal of clinically signi cant right-sided lesions and reduce the incentive to remove distal hyperplastic polyps. [20,44] Patient experience is a key aspect of healthcare quality. Comfort scores that are endoscopist reported have been criticised, as patients and endoscopists have been shown to have different priorities around the endoscopy experience.…”

“…In the development of the National Endoscopy Database Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) we undertook a qualitative interview study to explore the phenomenon of current A&F practices in colonoscopy to develop an A&F BCI. [20] The aim of this work is to explore the current phenomena of potential harms and adverse outcomes in A&F processes in endoscopy using a theoretical model based on FIT, to inform the design of a future BCI.…”

Impact of the National Endoscopy Database (NED) on colonoscopy withdrawal time: a tertiary centre experience

“…[32][33][34][35][36][37][38] The impact of automated feedback of NED KPIs on endoscopists and endoscopy leads is the current study area in a multicentre randomised controlled trial. 39 The differences in PDR between surgeons and gastroenterologists have been conflicting. 5 40 41 In a recent study of non-screening colonoscopies, 9 we found significant CWT and PDR variations among different groups of endoscopists according to their specialties.…”