Felippe O Marcondes1, Katie M Dean2, Robert E Schoen3, Daniel A Leffler4, Sherri Rose2, Michele Morris3, Ateev Mehrotra5. 1. The University of Texas Medical Branch at Galveston, Galveston, Texas. 2. Harvard Medical School, Boston, Massachusetts. 3. University of Pittsburgh, Pittsburgh, Pennsylvania. 4. Beth Israel Deaconess Medical Center, Boston, Massachusetts. 5. Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
BACKGROUND: The adenoma detection rate (ADR) is a validated and widely used measure of colonoscopy quality. There is uncertainty in the published literature as to which colonoscopy examinations should be excluded when measuring a physician's ADR. OBJECTIVE: To examine the impact of varying the colonoscopy exclusion criteria on physician ADR. DESIGN: We applied different exclusion criteria used in 30 previous studies to a dataset of endoscopy and pathology reports. Under each exclusion criterion, we calculated physician ADR. SETTING: A private practice colonoscopy center affiliated with the University of Illinois College of Medicine. PATIENTS: Data on 20,040 colonoscopy examinations performed by 11 gastroenterologists from July 2009 to May 2013 and associated pathology notes. MAIN OUTCOME MEASUREMENTS: ADRs across all colonoscopy examinations, each physician's ADR, and ADR ranking. RESULTS: There were 28 different exclusion criteria used when measuring the ADR. Each study used a different combination of these exclusion criteria. The proportion of all colonoscopy examinations in the dataset excluded under these combinations of exclusion criteria ranged from 0% to 92.2%. The mean ADR across all colonoscopy examinations was 39.1%. The change in mean ADR after applying the 28 exclusion criteria ranged from -5.5 to +3.0 percentage points. However, the exclusion criteria affected each physician's ADR relatively equally, and therefore physicians' rankings via the ADR were stable. LIMITATIONS: ADR assessment was limited to a single private endoscopy center. CONCLUSION: There is wide variation in the exclusion criteria used when measuring the ADR. Although these exclusion criteria can affect overall ADRs, the relative rankings of physicians by ADR were stable. A consensus definition of which exclusion criteria are applied when measuring ADR is needed.
BACKGROUND: The adenoma detection rate (ADR) is a validated and widely used measure of colonoscopy quality. There is uncertainty in the published literature as to which colonoscopy examinations should be excluded when measuring a physician's ADR. OBJECTIVE: To examine the impact of varying the colonoscopy exclusion criteria on physician ADR. DESIGN: We applied different exclusion criteria used in 30 previous studies to a dataset of endoscopy and pathology reports. Under each exclusion criterion, we calculated physician ADR. SETTING: A private practice colonoscopy center affiliated with the University of Illinois College of Medicine. PATIENTS: Data on 20,040 colonoscopy examinations performed by 11 gastroenterologists from July 2009 to May 2013 and associated pathology notes. MAIN OUTCOME MEASUREMENTS: ADRs across all colonoscopy examinations, each physician's ADR, and ADR ranking. RESULTS: There were 28 different exclusion criteria used when measuring the ADR. Each study used a different combination of these exclusion criteria. The proportion of all colonoscopy examinations in the dataset excluded under these combinations of exclusion criteria ranged from 0% to 92.2%. The mean ADR across all colonoscopy examinations was 39.1%. The change in mean ADR after applying the 28 exclusion criteria ranged from -5.5 to +3.0 percentage points. However, the exclusion criteria affected each physician's ADR relatively equally, and therefore physicians' rankings via the ADR were stable. LIMITATIONS: ADR assessment was limited to a single private endoscopy center. CONCLUSION: There is wide variation in the exclusion criteria used when measuring the ADR. Although these exclusion criteria can affect overall ADRs, the relative rankings of physicians by ADR were stable. A consensus definition of which exclusion criteria are applied when measuring ADR is needed.
Authors: Henk Harkema; Wendy W Chapman; Melissa Saul; Evan S Dellon; Robert E Schoen; Ateev Mehrotra Journal: J Am Med Inform Assoc Date: 2011-09-21 Impact factor: 4.497
Authors: Douglas K Rex; John L Petrini; Todd H Baron; Amitabh Chak; Jonathan Cohen; Stephen E Deal; Brenda Hoffman; Brian C Jacobson; Klaus Mergener; Bret T Petersen; Michael A Safdi; Douglas O Faigel; Irving M Pike Journal: Am J Gastroenterol Date: 2006-04 Impact factor: 10.864
Authors: Thomas J W Lee; Matthew D Rutter; Roger G Blanks; Sue M Moss; Andrew F Goddard; Andrew Chilton; Claire Nickerson; Richard J Q McNally; Julietta Patnick; Colin J Rees Journal: Gut Date: 2011-09-22 Impact factor: 23.059
Authors: Joshua C Denny; Neesha N Choma; Josh F Peterson; Randolph A Miller; Lisa Bastarache; Ming Li; Neeraja B Peterson Journal: Med Decis Making Date: 2011-03-10 Impact factor: 2.583
Authors: David P Gerard; Diane B Foster; Manfred W Raiser; John L Holden; Theodore G Karrison Journal: Clin Transl Gastroenterol Date: 2013-12-05 Impact factor: 4.488
Authors: Robert J Hilsden; Ronald Bridges; Catherine Dube; S Elizabeth McGregor; Christopher Naugler; Sarah M Rose; Alaa Rostom; Steven J Heitman Journal: Am J Gastroenterol Date: 2016-10-11 Impact factor: 10.864
Authors: Ateev Mehrotra; Michele Morris; Rebecca A Gourevitch; David S Carrell; Daniel A Leffler; Sherri Rose; Julia B Greer; Seth D Crockett; Andrew Baer; Robert E Schoen Journal: Gastrointest Endosc Date: 2017-09-01 Impact factor: 9.427
Authors: Joseph C Anderson; Audrey H Calderwood; Brock C Christensen; Christina M Robinson; Christopher I Amos; Lynn Butterly Journal: Am J Gastroenterol Date: 2018-11-01 Impact factor: 10.864
Authors: Eelco C Brand; Julia E Crook; Colleen S Thomas; Peter D Siersema; Douglas K Rex; Michael B Wallace Journal: PLoS One Date: 2017-09-28 Impact factor: 3.240