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Effect of quality metric monitoring and colonoscopy performance

Background and aims: Adenoma detection rate (ADR) and cecal withdrawal time (CWT) have been identified as measures of colonoscopy quality. This study evaluates the impact of monitoring these measures on provider performance. Methods: Six blinded gastroenterologists practicing at a Veterans Affairs M...

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Autores principales: Razzak, Anthony, Smith, Dineen, Zahid, Maliha, Papachristou, Georgios, Khalid, Asif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2016
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063644/
https://www.ncbi.nlm.nih.gov/pubmed/27747273
http://dx.doi.org/10.1055/s-0042-110787
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author Razzak, Anthony
Smith, Dineen
Zahid, Maliha
Papachristou, Georgios
Khalid, Asif
author_facet Razzak, Anthony
Smith, Dineen
Zahid, Maliha
Papachristou, Georgios
Khalid, Asif
author_sort Razzak, Anthony
collection PubMed
description Background and aims: Adenoma detection rate (ADR) and cecal withdrawal time (CWT) have been identified as measures of colonoscopy quality. This study evaluates the impact of monitoring these measures on provider performance. Methods: Six blinded gastroenterologists practicing at a Veterans Affairs Medical Center were prospectively monitored over 9 months. Data for screening, adenoma surveillance, and fecal occult blood test positive (FOBT +) indicated colonoscopies were obtained, including exam preparation quality, cecal intubation rate, CWT, ADR, adenomas per colonoscopy (APC), and adverse events. Metrics were continuously monitored after a period of informed CWT monitoring and informed CWT + ADR monitoring. The primary outcome was impact on ADR and APC. Results: A total of 1671 colonoscopies were performed during the study period with 540 before informed monitoring, 528 during informed CWT monitoring, and 603 during informed CWT + ADR monitoring. No statistically significant impact on ADR was noted across each study phase. Multivariate regression revealed a trend towards fewer adenomas removed during the CWT monitoring phase (OR = 0.79; 95 %CI 0.62 – 1.02, P = 0.065) and a trend towards more adenomas removed during the CWT + ADR monitoring phase when compared to baseline (OR = 1.26; 95 %CI 0.99 – 1.61, P = 0.062). Indication for examination and provider were significant predictors for higher APC. Provider-specific data demonstrated a direct relationship between high ADR performers and increased CWT. Conclusions: Monitoring quality metrics did not significantly alter colonoscopy performance across a small heterogeneous group of providers. Non-significant trends towards higher APC were noted with CWT + ADR monitoring. Providers with a longer CWT had a higher ADR. Further studies are needed to determine the impact of monitoring on colonoscopy performance.
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spelling pubmed-50636442016-10-14 Effect of quality metric monitoring and colonoscopy performance Razzak, Anthony Smith, Dineen Zahid, Maliha Papachristou, Georgios Khalid, Asif Endosc Int Open Background and aims: Adenoma detection rate (ADR) and cecal withdrawal time (CWT) have been identified as measures of colonoscopy quality. This study evaluates the impact of monitoring these measures on provider performance. Methods: Six blinded gastroenterologists practicing at a Veterans Affairs Medical Center were prospectively monitored over 9 months. Data for screening, adenoma surveillance, and fecal occult blood test positive (FOBT +) indicated colonoscopies were obtained, including exam preparation quality, cecal intubation rate, CWT, ADR, adenomas per colonoscopy (APC), and adverse events. Metrics were continuously monitored after a period of informed CWT monitoring and informed CWT + ADR monitoring. The primary outcome was impact on ADR and APC. Results: A total of 1671 colonoscopies were performed during the study period with 540 before informed monitoring, 528 during informed CWT monitoring, and 603 during informed CWT + ADR monitoring. No statistically significant impact on ADR was noted across each study phase. Multivariate regression revealed a trend towards fewer adenomas removed during the CWT monitoring phase (OR = 0.79; 95 %CI 0.62 – 1.02, P = 0.065) and a trend towards more adenomas removed during the CWT + ADR monitoring phase when compared to baseline (OR = 1.26; 95 %CI 0.99 – 1.61, P = 0.062). Indication for examination and provider were significant predictors for higher APC. Provider-specific data demonstrated a direct relationship between high ADR performers and increased CWT. Conclusions: Monitoring quality metrics did not significantly alter colonoscopy performance across a small heterogeneous group of providers. Non-significant trends towards higher APC were noted with CWT + ADR monitoring. Providers with a longer CWT had a higher ADR. Further studies are needed to determine the impact of monitoring on colonoscopy performance. © Georg Thieme Verlag KG 2016-10 2016-08-05 /pmc/articles/PMC5063644/ /pubmed/27747273 http://dx.doi.org/10.1055/s-0042-110787 Text en © Thieme Medical Publishers
spellingShingle Razzak, Anthony
Smith, Dineen
Zahid, Maliha
Papachristou, Georgios
Khalid, Asif
Effect of quality metric monitoring and colonoscopy performance
title Effect of quality metric monitoring and colonoscopy performance
title_full Effect of quality metric monitoring and colonoscopy performance
title_fullStr Effect of quality metric monitoring and colonoscopy performance
title_full_unstemmed Effect of quality metric monitoring and colonoscopy performance
title_short Effect of quality metric monitoring and colonoscopy performance
title_sort effect of quality metric monitoring and colonoscopy performance
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063644/
https://www.ncbi.nlm.nih.gov/pubmed/27747273
http://dx.doi.org/10.1055/s-0042-110787
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