Sey Michael Sai Lai, Liu Andy, Asfaha Samuel, Siebring Victoria, Jairath Vipul, Yan Brian
Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
Department of Medicine, Western University, London, Ontario, Canada.
Endosc Int Open. 2017 Jul;5(7):E675-E682. doi: 10.1055/s-0043-110568. Epub 2017 Jul 6.
Adenoma detection rate (ADR) is an important measure of colonoscopy quality, as are polyp, advanced ADR, and adenocarcinoma detection rates. We investigated whether performance report cards improved these outcome measures.
Endoscopists were given report cards comparing their detection rates to the institutional mean on an annual basis. Detection rates were evaluated at baseline, 1 year after report cards (Year 1), and 2 years after report cards (Year 2). Endoscopists were unaware of the study and received no other interventions. The primary outcome was ADR and secondary outcomes were polyp detection rate (PDR), advanced ADR, and adenocarcinoma detection rate. Multivariate regression was performed to adjust for temporal trends in patient, endoscopists, and procedural factors.
Seventeen physicians performed 3,118 screening colonoscopies in patients with positive FOBT or family history of colon cancer. The ADR increased from 34.5 % (baseline) to 39.4 % (Year 1) and 41.2 % (Year 2) ( = 0.0037). The PDR increased from 45 % (baseline) to 48.8 % (Year 1) and 51.8 % (Year 2) ( = 0.011). There was no significant improvement in advanced ADR or adenocarcinoma detection rates. On multivariate analysis, the ADR increased by 22 % in Year 1 ( = 0.03) and 30 % in Year 2 ( = 0.008). Among physicians with a baseline ADR < 25 %, improvement in ADR was even greater, increasing 2.2 times by the end of the study ( = 0.004). Improvements in ADR were not correlated with specialty although gastroenterologists were 52 % more likely to find an adenoma than general surgeons.
Annual performance report cards increased adenoma detection rates, especially among physicians with low ADR < 25 %.
腺瘤检出率（ADR）是衡量结肠镜检查质量的一项重要指标，息肉、高级别腺瘤检出率及腺癌检出率亦是如此。我们调查了绩效报告卡是否能改善这些结果指标。
每年为内镜医师提供报告卡，将他们的检出率与机构均值进行比较。在基线期、报告卡发放后1年（第1年）和报告卡发放后2年（第2年）对检出率进行评估。内镜医师对该研究不知情，且未接受其他干预措施。主要结局指标为ADR，次要结局指标为息肉检出率（PDR）、高级别腺瘤检出率及腺癌检出率。进行多变量回归分析以校正患者、内镜医师及操作因素的时间趋势。
17名医师对3118例粪便潜血试验阳性或有结肠癌家族史的患者进行了筛查结肠镜检查。ADR从34.5%（基线期）增至39.4%（第1年）和41.2%（第2年）（P = 0.0037）。PDR从45%（基线期）增至48.8%（第1年）和51.8%（第2年）（P = 0.011）。高级别腺瘤检出率或腺癌检出率无显著改善。多变量分析显示，ADR在第1年增加了22%（P = 0.03），在第2年增加了30%（P = 0.008）。在基线ADR<25%的医师中，ADR的改善更为显著，到研究结束时增加了2.2倍（P = 0.004）。ADR的改善与专业无关，尽管胃肠病学家发现腺瘤的可能性比普通外科医生高52%。
年度绩效报告卡提高了腺瘤检出率，尤其是在ADR<25%的医师中。
