Lyndon V Hernandez1, Thomas M Deas2, Marc F Catalano3, Nalini M Guda3, Lin Huang4, Scott R Ketover5, Kyle P Etzkorn6, Kumar G Gutta2, Steve J Morris7, Michael J Schmalz3, Dominic Klyve8, John I Allen9. 1. GI Associates and Medical College of Wisconsin, Milwaukee, Wisconsin. 2. Gastroenterology Associates of North Texas, Fort Worth, Texas. 3. GI Associates, LLC, Milwaukee, Wisconsin. 4. Digestive Health Specialists, Tacoma, Washington. 5. Minnesota Gastroenterology, Minneapolis, Minnesota. 6. Borland-Groover Clinic, Jacksonville, Florida. 7. Atlanta Gastroenterology Associates, Atlanta, Georgia. 8. Central Washington University, Ellensburg, Washington. 9. Yale University, New Haven, Connecticut.
Abstract
BACKGROUND: There is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level. OBJECTIVE: To evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation. DESIGN: Observational cross-sectional analysis. SETTING: Collaborative quality metrics database from 2007 to 2012. PATIENTS: Patients who underwent colonoscopies in ambulatory surgery centers. INTERVENTIONS: Colonoscopy. MAIN OUTCOME MEASUREMENTS: The number of colonoscopies with an adenomatous polyp divided by the total number of colonoscopies (ADR-T), inclusive of indication and patient's sex. RESULTS: Data from 368,157 colonoscopies were included for analysis from 11 practices. Three practice sites (5, 8, and 10) were significantly above and 2 sites (3, 7) were significantly below mean ADR-T, with a 95% confidence interval (CI). High-performing sites had 9.0% higher ADR-T than sites belonging to the lowest quartile (P < .001). The mean ADR-T remained stable for 9 of 11 sites. Regression analysis showed that the 2 practice sites where ADR-T varied had significant improvements in ADR-T during the 6-year period. For each, mean ADR-T improved an average of 0.5% per quarter for site 2 (P = .001) and site 3 (P = .021), which were average and low performers, respectively. LIMITATIONS: Summary-level data, which does not allow cross-reference of variables at an individual level. CONCLUSION: We found performance disparities among practice sites remaining relatively consistent over a 6-year period. The ability of certain sites to sustain their high-performance over 6 years suggests that further research is needed to identify key organizational processes and physician incentives that improve the quality of colonoscopy.
BACKGROUND: There is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level. OBJECTIVE: To evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation. DESIGN: Observational cross-sectional analysis. SETTING: Collaborative quality metrics database from 2007 to 2012. PATIENTS: Patients who underwent colonoscopies in ambulatory surgery centers. INTERVENTIONS: Colonoscopy. MAIN OUTCOME MEASUREMENTS: The number of colonoscopies with an adenomatous polyp divided by the total number of colonoscopies (ADR-T), inclusive of indication and patient's sex. RESULTS: Data from 368,157 colonoscopies were included for analysis from 11 practices. Three practice sites (5, 8, and 10) were significantly above and 2 sites (3, 7) were significantly below mean ADR-T, with a 95% confidence interval (CI). High-performing sites had 9.0% higher ADR-T than sites belonging to the lowest quartile (P < .001). The mean ADR-T remained stable for 9 of 11 sites. Regression analysis showed that the 2 practice sites where ADR-T varied had significant improvements in ADR-T during the 6-year period. For each, mean ADR-T improved an average of 0.5% per quarter for site 2 (P = .001) and site 3 (P = .021), which were average and low performers, respectively. LIMITATIONS: Summary-level data, which does not allow cross-reference of variables at an individual level. CONCLUSION: We found performance disparities among practice sites remaining relatively consistent over a 6-year period. The ability of certain sites to sustain their high-performance over 6 years suggests that further research is needed to identify key organizational processes and physician incentives that improve the quality of colonoscopy.
Authors: Gottumukkala S Raju; Phillip J Lum; Rebecca S Slack; Selvi Thirumurthi; Patrick M Lynch; Ethan Miller; Brian R Weston; Marta L Davila; Manoop S Bhutani; Mehnaz A Shafi; Robert S Bresalier; Alexander A Dekovich; Jeffrey H Lee; Sushovan Guha; Mala Pande; Boris Blechacz; Asif Rashid; Mark Routbort; Gladis Shuttlesworth; Lopa Mishra; John R Stroehlein; William A Ross Journal: Gastrointest Endosc Date: 2015-04-22 Impact factor: 9.427
Authors: Suqing Li; Marc Monachese; Misbah Salim; Naveen Arya; Anand V Sahai; Nauzer Forbes; Christopher Teshima; Mohammad Yaghoobi; Yen-I Chen; Eric Lam; Paul James Journal: Endosc Ultrasound Date: 2021 Mar-Apr Impact factor: 5.628