Suradkar Kunal, Lebwohl Benjamin, Kiran Ravi P, Lee-Kong Steven
Division of Colorectal Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, USA.
Division of Gastroenterology, Columbia University Medical Center/NewYork-Presbyterian Hospital, USA.
Gastroenterol Res Pract. 2019 Jul 22;2019:4276520. doi: 10.1155/2019/4276520. eCollection 2019.
Since 2011, our institution has distributed annual reports, in June, to providers with personalized data regarding adenoma detection rate (ADR), colonoscope withdrawal time (CW), and cecal intubation (CI) rate, using standardized reporting systems. We examined the impact of distribution of individualized reports at the midpoint of each year on colonoscopy outcomes in the latter half of each year.
Providers with endoscopy privileges, performing ≥20 colonoscopies/year, at our center throughout a five-year period (2011-2015) were included. The three metrics recorded and reported were ADR, CW, and CI using standard benchmark rates. The mean values of each metric from January through June (1 half) and July through December (2 half) were calculated. Curve estimation test was used to determine the significance of ADR in the respective time period.
Fifteen providers were eligible for the study. Collective ADR in the 1 half of all years was 26.9% and in the second half of all years was 28.1% ( = 0.476). CW for all years was more than 9 minutes while CI was above 90% for all providers. There was no significant increase in the CI and CW during the 5-year study period. Overall, ADR increased from 26.43% (2011) to 33.47% (2015) ( = 0.137). When examining ADR during each of the 12 months following the June report cards, there was no month-to-month trend observed ( = 0.893).
Endoscopists at our institutions met/exceeded the quality metrics in the first half of each year from the beginning of the study. Routine reporting may maintain, but not improve, outcomes. Long-term studies to determine if periodic feedback to endoscopists improves the quality of endoscopy as per national standards for detection of early colorectal cancers are required.
自2011年起,我们机构每年6月都会使用标准化报告系统向医疗服务提供者分发年度报告,其中包含腺瘤检出率(ADR)、结肠镜退镜时间(CW)和盲肠插管(CI)率的个性化数据。我们研究了每年年中分发个性化报告对下半年结肠镜检查结果的影响。
纳入在我们中心具有内镜操作权限、在五年期间(2011 - 2015年)每年进行≥20次结肠镜检查的医疗服务提供者。使用标准基准率记录和报告的三个指标为ADR、CW和CI。计算每个指标在1月至6月(上半年)和7月至12月(下半年)的平均值。采用曲线估计检验确定各时间段内ADR的显著性。
15名医疗服务提供者符合研究条件。所有年份上半年的总体ADR为26.9%,下半年为28.1%(P = 0.476)。所有年份的CW均超过9分钟,所有医疗服务提供者的CI均高于90%。在为期5年的研究期间,CI和CW没有显著增加。总体而言,ADR从2011年的26.43%增至2015年的33.47%(P = 0.137)。在查看6月报告卡后的12个月中,每月的ADR均未观察到逐月变化趋势(P = 0.893)。
从研究开始,我们机构的内镜医师在每年上半年均达到/超过了质量指标。常规报告可能维持但不会改善检查结果。需要进行长期研究,以确定按照早期结直肠癌检测的国家标准,定期向内镜医师提供反馈是否能提高内镜检查质量。