Heitham Abdul-Baki1, Robert E Schoen1, Katie Dean2, Sherri Rose2, Daniel A Leffler3, Eliathamby Kuganeswaran4, Michele Morris1, David Carrell5, Ateev Mehrotra6. 1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 2. Harvard Medical School, Boston, Massachusetts, USA. 3. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 4. Central Illinois Endoscopy Center, Peoria, Illinois, USA. 5. Group Health Cooperative Research Institute, Seattle, Washington, USA. 6. Harvard Medical School, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Colonoscopy is the predominant method for colorectal cancer screening in the United States. Previous 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 examinations and an indicator of the likelihood of subsequent colorectal cancer. There is interest in mechanisms to improve the ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality. OBJECTIVE: We assessed whether this initiative was associated with an improvement in the ADR. DESIGN: We compared ADRs before and after public reporting at a private practice endoscopy center with 11 gastroenterologists in Peoria, Illinois, who participated in the initiative. To generate the ADR, colonoscopy and pathology reports from examinations performed over 4 years at the endoscopy center were analyzed by using previously validated natural language processing software. SETTING: A central Illinois endoscopy center. RESULTS: The ADR in the pre-public reporting period was 34.3% and 39.2% in the post-public reporting period (an increase of 4.9%, P < .001). The increase in the right-sided ADR was 5.1% (P < .01), whereas the increase in the left-sided ADR was 2.1% (P < .05). The increase in the ADR was 7.8% for screening colonoscopies (P < 0.05) and 3.5% for nonscreening colonoscopies (P < .05). All but 1 physician's ADR increased (range -2.7% to 10.5%). There was no statistically significant change in the advanced ADR (increase of 0.8%, P = .22). LIMITATIONS: 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 an increase in ADR.
BACKGROUND: Colonoscopy is the predominant method for colorectal cancer screening in the United States. Previous 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 examinations and an indicator of the likelihood of subsequent colorectal cancer. There is interest in mechanisms to improve the ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality. OBJECTIVE: We assessed whether this initiative was associated with an improvement in the ADR. DESIGN: We compared ADRs before and after public reporting at a private practice endoscopy center with 11 gastroenterologists in Peoria, Illinois, who participated in the initiative. To generate the ADR, colonoscopy and pathology reports from examinations performed over 4 years at the endoscopy center were analyzed by using previously validated natural language processing software. SETTING: A central Illinois endoscopy center. RESULTS: The ADR in the pre-public reporting period was 34.3% and 39.2% in the post-public reporting period (an increase of 4.9%, P < .001). The increase in the right-sided ADR was 5.1% (P < .01), whereas the increase in the left-sided ADR was 2.1% (P < .05). The increase in the ADR was 7.8% for screening colonoscopies (P < 0.05) and 3.5% for nonscreening colonoscopies (P < .05). All but 1 physician's ADR increased (range -2.7% to 10.5%). There was no statistically significant change in the advanced ADR (increase of 0.8%, P = .22). LIMITATIONS: 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 an increase in ADR.
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