Keswani Rajesh N, Yadlapati Rena, Gleason Kristine M, Ciolino Jody D, Manka Michael, O'Leary Kevin J, Barnard Cynthia, Pandolfino John E
Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Quality, Northwestern HealthCare, Chicago, Illinois, USA.
Am J Gastroenterol. 2015 Aug;110(8):1134-9. doi: 10.1038/ajg.2015.103. Epub 2015 Apr 14.
Adenoma-detection rates (ADRs) are associated with decreased interval colorectal cancer (CRC) rates and CRC mortality; quality improvement strategies focus on improving physician ADRs. The objective of this study was to examine the sequential effect of physician report cards and implementing institutional standards of practice (SOP) on ADRs.
Colonoscopy metrics were prospectively evaluated at a single academic medical center over a 23-month period (November 2012 to October 2014). ADRs were evaluated over three time periods-Period 1: Before initial report card distribution or SOP (November 2012 to March 2013); Period 2: After individualized report card distribution detailing physician and institutional ADRs (April 2013 to March 2014); Period 3: After second report card and SOP implementation (April 2014 to October 2014). The SOP required physicians to have a minimum 5-min withdrawal time in normal colonoscopies (WT) and an ADR minimum of 20%; those who did not meet benchmarks would require further training or endoscopy block time alterations. Only endoscopists averaging >15 colonoscopies/month were included in this analysis.
Twenty endoscopists met the inclusion criteria, performing 12,894 screening colonoscopies over the 23-month period. Following report card distribution, physician ADRs increased by 3% (P<0.001). SOP implementation resulted in a further significant increase in mean physician ADR of 8% (P<0.0001). Overall, mean ADR increased by 11% from Period 1 to Period 3 (P<0.0001). All physicians met the minimum 20% ADR benchmark during Period 3. Although ADRs significantly correlated with WT overall (r=0.45; 95% CI 0.01, 0.75; P=0.04), mean WT did not significantly increase from Period 1 to Period 3.
Our data suggest that distributing colonoscopy quality report cards resulted in a significant ADR improvement. Further, we report evidence that implementing SOP significantly improved ADRs beyond report card distribution and resulted in all endoscopists meeting minimum benchmarks. This suggests that report cards and SOPs may have an additive effect in improving colonoscopy quality, and their implementation in endoscopy labs should be encouraged.
腺瘤检出率（ADR）与间隔期结直肠癌（CRC）发病率及CRC死亡率的降低相关；质量改进策略侧重于提高医生的ADR。本研究的目的是探讨医生报告卡及实施机构实践标准（SOP）对ADR的相继影响。
在一家学术医疗中心对结肠镜检查指标进行了为期23个月（2012年11月至2014年10月）的前瞻性评估。ADR在三个时间段进行评估——第1阶段：在首次报告卡分发或SOP实施之前（2012年11月至2013年3月）；第2阶段：在分发详细列出医生和机构ADR的个性化报告卡之后（2013年4月至2014年3月）；第3阶段：在第二次报告卡及SOP实施之后（2014年4月至2014年10月）。SOP要求医生在正常结肠镜检查中有至少5分钟的退镜时间（WT）且ADR至少为20%；未达基准的医生将需要进一步培训或调整内镜检查阻滞时间。本分析仅纳入每月平均进行超过15例结肠镜检查的内镜医师。
20名内镜医师符合纳入标准，在23个月期间共进行了12,894例结肠镜筛查。报告卡分发后，医生的ADR提高了3%（P<0.001）。SOP的实施使医生的平均ADR进一步显著提高了8%（P<0.0001）。总体而言，从第1阶段到第3阶段，平均ADR提高了11%（P<0.0001）。在第3阶段，所有医生均达到了最低20%的ADR基准。尽管ADR总体上与WT显著相关（r=0.45；95%CI 0.01, 0.75；P=0.04），但从第1阶段到第3阶段，平均WT并未显著增加。
我们的数据表明，分发结肠镜检查质量报告卡可显著提高ADR。此外，我们报告的证据表明，实施SOP在报告卡分发的基础上显著提高了ADR，并使所有内镜医师达到了最低基准。这表明报告卡和SOP在提高结肠镜检查质量方面可能具有累加效应，应鼓励在内镜检查实验室实施。
