Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
Gastrointest Endosc. 2013 Jan;77(1):71-8. doi: 10.1016/j.gie.2012.08.038.
Endoscopist quality is benchmarked by the adenoma detection rate (ADR)-the proportion of cases with 1 or more adenomas removed. However, the ADR rewards the same credit for 1 versus more than 1 adenoma.
We evaluated whether 2 endoscopist groups could have a similar ADR but detect significantly different total adenomas.
We retrospectively measured the ADR and multiple measures of total adenoma yield, including a metric called ADR-Plus, the mean number of incremental adenomas after the first. We plotted ADR versus ADR-Plus to create 4 adenoma detection patterns: (1) optimal (↑ADR/↑ADR-Plus); (2) one and done (↑ADR/↓ADR-Plus); (3) all or none (↓ADR/↑ADR-Plus); (4) none and done (↓ADR/↓ADR-Plus).
Tertiary-care teaching hospital and 3 nonteaching facilities servicing the same patient pool.
A total of 3318 VA patients who underwent screening between 2005 and 2009.
ADR, mean total adenomas detected, advanced adenomas detected, ADR-Plus.
The ADR was 28.8% and 25.7% in the teaching (n = 1218) and nonteaching groups (n = 2100), respectively (P = .052). Although ADRs were relatively similar, the teaching site achieved 23.5%, 28.7%, and 29.5% higher mean total adenomas, advanced adenomas, and ADR-Plus versus nonteaching sites (P < .001). By coupling ADR with ADR-Plus, we identified more teaching endoscopists as optimal (57.1% vs 8.3%; P = .02), and more nonteaching endoscopists in the none and done category (42% vs 0%; P = .047).
External generalizability, nonrandomized study.
We found minimal ADR differences between the 2 endoscopist groups, but substantial differences in total adenomas; the ADR missed this difference. Coupling the ADR with other total adenoma metrics (eg, ADR-Plus) provides a more comprehensive assessment of adenoma clearance; implementing both would better distinguish high- from low-performing endoscopists.
腺瘤检出率（ADR）——切除 1 个或多个腺瘤的病例比例——是衡量内镜医生质量的基准。然而，ADR 对 1 个腺瘤和多个腺瘤的检出给予相同的分值。
我们评估 2 组内镜医生的 ADR 可能相似，但总腺瘤检出量是否存在显著差异。
我们回顾性地测量了 ADR 和多种总腺瘤检出量指标，包括一个称为 ADR-Plus 的指标，即首次检出后额外检出的腺瘤平均数。我们绘制了 ADR 与 ADR-Plus 的关系图，以创建 4 种腺瘤检出模式：（1）理想型（ADR 升高/ADR-Plus 升高）；（2）检出 1 个腺瘤即结束（ADR 升高/ADR-Plus 降低）；（3）要么没有要么全有（ADR 降低/ADR-Plus 升高）；（4）无腺瘤且结束（ADR 降低/ADR-Plus 降低）。
三级保健教学医院和 3 家为同一患者群体服务的非教学机构。
2005 年至 2009 年间接受筛查的 3318 例退伍军人事务部患者。
ADR、检出的平均总腺瘤数、检出的高级别腺瘤、ADR-Plus。
教学组（n = 1218）和非教学组（n = 2100）的 ADR 分别为 28.8%和 25.7%（P =.052）。尽管 ADR 相对相似，但教学组检出的平均总腺瘤、高级别腺瘤和 ADR-Plus 分别比非教学组高 23.5%、28.7%和 29.5%（P <.001）。通过将 ADR 与 ADR-Plus 相结合，我们发现有更多的教学内镜医生属于理想型（57.1% vs 8.3%；P =.02），而非教学内镜医生中有更多的无腺瘤且结束型（42% vs 0%；P =.047）。
外部推广性、非随机研究。
我们发现 2 组内镜医生的 ADR 差异很小，但总腺瘤数量存在显著差异；ADR 未能发现这一差异。将 ADR 与其他总腺瘤指标（如 ADR-Plus）相结合，可以更全面地评估腺瘤清除情况；同时采用这两种方法可以更好地区分高绩效和低绩效的内镜医生。
