Department of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Department of Internal Medicine, Blake Medical Center, Bradenton, FL, USA.
Surg Endosc. 2018 Mar;32(3):1141-1148. doi: 10.1007/s00464-017-5785-5. Epub 2017 Aug 15.
Adenoma detection rate (ADR) is a quality indicator for screening colonoscopy, but its calculation is time-consuming. Polyp detection rate (PDR) has been found to correlate with ADR; however, its use as a quality indicator has been criticized out of concern for endoscopists artificially inflating the PDR. We aim to evaluate whether active monitoring affects PDR.
In March 2015, 14 endoscopists were made aware that their personal PDRs would be tracked monthly as a quality improvement project. Endoscopists received a report of their individual monthly and cumulative PDR, departmental averages, and a benchmark PDR. Following the intervention, data were collected for consecutive patients undergoing average risk screening colonoscopy for six months. PDR, ADR, and adenoma to polyp detection ratio quotient (APDRQ) were compared to a six-month pre-intervention period.
2203 patients were included in the study. There was no statistically significant difference in PDR when comparing pre- and post-intervention (44 vs. 45%, OR 1.04; 95% CI 0.77-1.36). No statistically significant difference in ADR was observed when comparing pre- and post-intervention (29 vs. 30%, OR 1.03; 95% CI 0.64-1.52). There was no statistically significant difference in APDRQ when comparing pre- and post-intervention (0.67 vs. 0.66, OR 0.99; 95% CI 0.69-1.33).
Monthly report cards did not result in a change in PDR or APDRQ. In some environments, PDR can be used as a surrogate marker of ADR, despite endoscopist awareness that PDR is being measured.
腺瘤检出率（ADR）是筛查结肠镜检查的质量指标，但计算耗时。已发现息肉检出率（PDR）与 ADR 相关；然而，由于担心内镜医生人为提高 PDR，其作为质量指标的使用受到了批评。我们旨在评估主动监测是否会影响 PDR。
2015 年 3 月，14 名内镜医生意识到他们的个人 PDR 将作为一项质量改进项目每月进行跟踪。内镜医生收到了他们个人每月和累计 PDR、科室平均值以及基准 PDR 的报告。干预后，连续 6 个月对接受平均风险筛查结肠镜检查的患者进行了数据收集。比较了干预前后的 PDR、ADR 和腺瘤到息肉检出比商（APDRQ）。
共纳入 2203 例患者。干预前后 PDR 无统计学差异（44%比 45%，OR 1.04；95%CI 0.77-1.36）。干预前后 ADR 无统计学差异（29%比 30%，OR 1.03；95%CI 0.64-1.52）。干预前后 APDRQ 无统计学差异（0.67 比 0.66，OR 0.99；95%CI 0.69-1.33）。
每月报告卡并未导致 PDR 或 APDRQ 发生变化。在某些环境下，尽管内镜医生知道正在测量 PDR，但 PDR 可以作为 ADR 的替代标志物。
