Jennifer A Inra1,2, Jennifer Nayor3,4, Margery Rosenblatt5, Muthoka Mutinga1,2, Sarathchandra I Reddy6, Sapna Syngal1,2,5, Fay Kastrinos7,8. 1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 2. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. 3. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. jnayor@partners.org. 4. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. jnayor@partners.org. 5. Division of Population Sciences, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA, 02115, USA. 6. Division of Gastroenterology, South Shore Hospital, 1681 Washington Street, Braintree, South Weymouth, MA, 02184, USA. 7. Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA. 8. Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
Abstract
BACKGROUND: Quality performance measures for screening colonoscopy vary among endoscopists. The impact of practice setting is unknown. AIMS: We aimed to (1) compare screening colonoscopy performance measures among three different US practice settings; (2) evaluate factors associated with adenoma detection; and (3) assess a scorecard intervention on performance metrics. METHODS: This multi-center prospective study compared patient, endoscopist, and colonoscopy characteristics performed at a tertiary care hospital (TCH), community-based hospital (CBH), and private practice group (PPG). Withdrawal times (WT), cecal intubation, and adenoma detection rates (ADR) were compared by site at baseline and 12 weeks following scorecard distribution. Generalized linear mixed models identified factors associated with adenoma detection. RESULTS: Twenty-eight endoscopists performed colonoscopies on 1987 asymptomatic, average-risk individuals ≥50 years. Endoscopist and patient characteristics were similar across sites. The PPG screened more men (TCH: 42.8%, CBH: 45.0%, PPG: 54.2%; p < 0.0001). Preparation quality varied with good/excellent results in 70.6, 88.3, and 92% of TCH, CBH, and PPG cases, respectively (p < 0.0001). Male ADRs, cecal intubation, and WT exceeded recommended benchmarks despite variable results at each site; female ADRs were <15% at the PPG which screened the fewest females. Performance remained unchanged following scorecard distribution. Adenoma detection was associated with increasing patient age, male gender, WT, adequate preparation, but not practice setting. CONCLUSIONS: Each practice performed high-quality screening colonoscopy. Scorecards did not improve performance metrics. Preparation quality varies among practice settings and can be modified to improve adenoma detection.
BACKGROUND: Quality performance measures for screening colonoscopy vary among endoscopists. The impact of practice setting is unknown. AIMS: We aimed to (1) compare screening colonoscopy performance measures among three different US practice settings; (2) evaluate factors associated with adenoma detection; and (3) assess a scorecard intervention on performance metrics. METHODS: This multi-center prospective study compared patient, endoscopist, and colonoscopy characteristics performed at a tertiary care hospital (TCH), community-based hospital (CBH), and private practice group (PPG). Withdrawal times (WT), cecal intubation, and adenoma detection rates (ADR) were compared by site at baseline and 12 weeks following scorecard distribution. Generalized linear mixed models identified factors associated with adenoma detection. RESULTS: Twenty-eight endoscopists performed colonoscopies on 1987 asymptomatic, average-risk individuals ≥50 years. Endoscopist and patient characteristics were similar across sites. The PPG screened more men (TCH: 42.8%, CBH: 45.0%, PPG: 54.2%; p < 0.0001). Preparation quality varied with good/excellent results in 70.6, 88.3, and 92% of TCH, CBH, and PPG cases, respectively (p < 0.0001). Male ADRs, cecal intubation, and WT exceeded recommended benchmarks despite variable results at each site; female ADRs were <15% at the PPG which screened the fewest females. Performance remained unchanged following scorecard distribution. Adenoma detection was associated with increasing patient age, male gender, WT, adequate preparation, but not practice setting. CONCLUSIONS: Each practice performed high-quality screening colonoscopy. Scorecards did not improve performance metrics. Preparation quality varies among practice settings and can be modified to improve adenoma detection.
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: Reena V Chokshi; Christine E Hovis; Thomas Hollander; Dayna S Early; Jean S Wang Journal: Gastrointest Endosc Date: 2012-02-28 Impact factor: 9.427
Authors: Reinier G S Meester; Chyke A Doubeni; Iris Lansdorp-Vogelaar; Christopher D Jensen; Miriam P van der Meulen; Theodore R Levin; Virginia P Quinn; Joanne E Schottinger; Ann G Zauber; Douglas A Corley; Marjolein van Ballegooijen Journal: JAMA Date: 2015-06-16 Impact factor: 56.272
Authors: Brenda K Edwards; Anne-Michelle Noone; Angela B Mariotto; Edgar P Simard; Francis P Boscoe; S Jane Henley; Ahmedin Jemal; Hyunsoon Cho; Robert N Anderson; Betsy A Kohler; Christie R Eheman; Elizabeth M Ward Journal: Cancer Date: 2013-12-16 Impact factor: 6.860
Authors: Mandeep S Sawhney; Marcelo S Cury; Naama Neeman; Long H Ngo; Janet M Lewis; Ram Chuttani; Douglas K Pleskow; Mark D Aronson Journal: Gastroenterology Date: 2008-08-27 Impact factor: 22.682
Authors: Thomas J W Lee; Colin J Rees; Roger G Blanks; Sue M Moss; Claire Nickerson; Karen C Wright; Peter W James; Richard J Q McNally; Julietta Patnick; Matthew D Rutter Journal: Endoscopy Date: 2014-01-28 Impact factor: 10.093
Authors: Karl M Langberg; Yauheni Solad; Maria Ciarleglio; Nitin Sukumar; Pavel Teslya; Mohommed M Chowdhury; Harry R Aslanian Journal: Dig Dis Sci Date: 2017-03-27 Impact factor: 3.199
Authors: Jae Gon Lee; Dong Soo Han; Young-Eun Joo; Dae-Seong Myung; Dong Il Park; Seul Ki Kim; Yunho Jung; Won Hyun Lee; Eun Soo Kim; Joon Seok Yoon; Chang Soo Eun Journal: Korean J Intern Med Date: 2020-05-12 Impact factor: 2.884