VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
Dig Dis Sci. 2021 Sep;66(9):3149-3155. doi: 10.1007/s10620-020-06627-2. Epub 2020 Oct 8.
Adenoma detection rate (ADR) is the colonoscopy quality metric with the strongest association to interval or "missed" cancer. Accurate measurement of ADR can be laborious and costly.
Our aim was to determine if administrative procedure codes for colonoscopy and text searches of pathology results for adenoma mentions could estimate ADR.
We identified US Veterans with a colonoscopy using Current Procedure Terminology (CPT) codes between January 2013 and December 2016 at ten Veterans Affairs sites. We applied simple text searches using Microsoft SQL Server full-text searches to query all pathology notes for "adenoma(s)" or "adenomatous" text mentions to calculate ADRs. To validate our identification of colonoscopy procedures, endoscopists of record, and adenoma detection from the electronic health record, we manually reviewed a random sample of 2000 procedure and pathology notes from the 10 sites.
Structured data fields were accurate in identification of colonoscopies being performed (PPV = 0.99; 95% CI 0.99-1.00) and identifying the endoscopist of record (PPV of 0.95; 95% CI 0.94-0.96) for ADR measurement. Simple text searches of pathology notes for adenoma mentions had excellent performance statistics as follows: sensitivity 0.99 (95% CI 0.98-1.00), specificity 0.93 (95% CI 0.92-0.95), NPV 0.99 (95% CI 0.98-1.00), and PPV 0.93 (0.91-0.94) for measurement of ADR. There was no clinically significant difference in the estimates of overall ADR vs. screening ADR (p > 0.05).
Measuring ADR using administrative codes and text searches from pathology results is an efficient method to broadly survey colonoscopy quality.
腺瘤检出率（ADR）是与间隔期或“遗漏”癌症关联最强的结肠镜检查质量指标。ADR 的准确测量可能既费力又昂贵。
我们的目的是确定结肠镜检查的行政程序代码和病理结果中腺瘤提及的文本搜索是否可以估计 ADR。
我们在美国退伍军人事务部的十个地点，使用 2013 年 1 月至 2016 年 12 月之间的现行程序术语（CPT）代码，确定了接受结肠镜检查的患者。我们使用 Microsoft SQL Server 全文搜索，对所有病理记录进行简单的文本搜索，查询“腺瘤（s）”或“腺瘤性”文本提及，以计算 ADR。为了验证我们对结肠镜检查程序、记录内镜医生和电子健康记录中腺瘤检出率的识别，我们对十个地点的 2000 份程序和病理记录进行了随机样本的手动审查。
结构化数据字段在识别进行的结肠镜检查（PPV=0.99；95%CI 0.99-1.00）和识别记录内镜医生（PPV 为 0.95；95%CI 0.94-0.96）方面具有很高的准确性。对病理记录中腺瘤提及的简单文本搜索具有出色的性能统计数据，如下所示：灵敏度 0.99（95%CI 0.98-1.00），特异性 0.93（95%CI 0.92-0.95），NPV 0.99（95%CI 0.98-1.00），PPV 0.93（0.91-0.94），用于测量 ADR。总体 ADR 与筛查 ADR 的估计值之间没有临床显著差异（p>0.05）。
使用行政代码和病理结果中的文本搜索来衡量 ADR 是广泛调查结肠镜检查质量的有效方法。
