BACKGROUND: Endoscopist quality is benchmarked by the adenoma detection rate (ADR)-the proportion of cases with 1 or more adenomas removed. However, the ADR rewards the same credit for 1 versus more than 1 adenoma. OBJECTIVE: We evaluated whether 2 endoscopist groups could have a similar ADR but detect significantly different total adenomas. DESIGN: We retrospectively measured the ADR and multiple measures of total adenoma yield, including a metric called ADR-Plus, the mean number of incremental adenomas after the first. We plotted ADR versus ADR-Plus to create 4 adenoma detection patterns: (1) optimal (↑ADR/↑ADR-Plus); (2) one and done (↑ADR/↓ADR-Plus); (3) all or none (↓ADR/↑ADR-Plus); (4) none and done (↓ADR/↓ADR-Plus). SETTING: Tertiary-care teaching hospital and 3 nonteaching facilities servicing the same patient pool. PATIENTS: A total of 3318 VA patients who underwent screening between 2005 and 2009. MAIN OUTCOME MEASUREMENTS: ADR, mean total adenomas detected, advanced adenomas detected, ADR-Plus. RESULTS: The ADR was 28.8% and 25.7% in the teaching (n = 1218) and nonteaching groups (n = 2100), respectively (P = .052). Although ADRs were relatively similar, the teaching site achieved 23.5%, 28.7%, and 29.5% higher mean total adenomas, advanced adenomas, and ADR-Plus versus nonteaching sites (P < .001). By coupling ADR with ADR-Plus, we identified more teaching endoscopists as optimal (57.1% vs 8.3%; P = .02), and more nonteaching endoscopists in the none and done category (42% vs 0%; P = .047). LIMITATIONS: External generalizability, nonrandomized study. CONCLUSION: We found minimal ADR differences between the 2 endoscopist groups, but substantial differences in total adenomas; the ADR missed this difference. Coupling the ADR with other total adenoma metrics (eg, ADR-Plus) provides a more comprehensive assessment of adenoma clearance; implementing both would better distinguish high- from low-performing endoscopists.
BACKGROUND: Endoscopist quality is benchmarked by the adenoma detection rate (ADR)-the proportion of cases with 1 or more adenomas removed. However, the ADR rewards the same credit for 1 versus more than 1 adenoma. OBJECTIVE: We evaluated whether 2 endoscopist groups could have a similar ADR but detect significantly different total adenomas. DESIGN: We retrospectively measured the ADR and multiple measures of total adenoma yield, including a metric called ADR-Plus, the mean number of incremental adenomas after the first. We plotted ADR versus ADR-Plus to create 4 adenoma detection patterns: (1) optimal (↑ADR/↑ADR-Plus); (2) one and done (↑ADR/↓ADR-Plus); (3) all or none (↓ADR/↑ADR-Plus); (4) none and done (↓ADR/↓ADR-Plus). SETTING: Tertiary-care teaching hospital and 3 nonteaching facilities servicing the same patient pool. PATIENTS: A total of 3318 VApatients who underwent screening between 2005 and 2009. MAIN OUTCOME MEASUREMENTS: ADR, mean total adenomas detected, advanced adenomas detected, ADR-Plus. RESULTS: The ADR was 28.8% and 25.7% in the teaching (n = 1218) and nonteaching groups (n = 2100), respectively (P = .052). Although ADRs were relatively similar, the teaching site achieved 23.5%, 28.7%, and 29.5% higher mean total adenomas, advanced adenomas, and ADR-Plus versus nonteaching sites (P < .001). By coupling ADR with ADR-Plus, we identified more teaching endoscopists as optimal (57.1% vs 8.3%; P = .02), and more nonteaching endoscopists in the none and done category (42% vs 0%; P = .047). LIMITATIONS: External generalizability, nonrandomized study. CONCLUSION: We found minimal ADR differences between the 2 endoscopist groups, but substantial differences in total adenomas; the ADR missed this difference. Coupling the ADR with other total adenoma metrics (eg, ADR-Plus) provides a more comprehensive assessment of adenoma clearance; implementing both would better distinguish high- from low-performing endoscopists.
Authors: Vivian Ussui; Susan Coe; Cynthia Rizk; Julia E Crook; Nancy N Diehl; Michael B Wallace Journal: Am J Gastroenterol Date: 2014-09-30 Impact factor: 10.864
Authors: Timothy D Imler; Justin Morea; Charles Kahi; Eric A Sherer; Jon Cardwell; Cynthia S Johnson; Huiping Xu; Dennis Ahnen; Fadi Antaki; Christopher Ashley; Gyorgy Baffy; Ilseung Cho; Jason Dominitz; Jason Hou; Mark Korsten; Anil Nagar; Kittichai Promrat; Douglas Robertson; Sameer Saini; Amandeep Shergill; Walter Smalley; Thomas F Imperiale Journal: Am J Gastroenterol Date: 2015-03-10 Impact factor: 10.864
Authors: Cassandra D L Fritz; Zachary L Smith; Jeffrey Elsner; Thomas Hollander; Dayna Early; Vladimir Kushnir Journal: Dig Dis Sci Date: 2018-05-03 Impact factor: 3.199