Colonoscopy Quality

Abstract

Synopsis Colonoscopy is an excellent area for quality improvement 1 because it is high volume, has significant associated risk and expense, and there is evidence that variability in its performance affects outcomes. The best endpoint for validation of quality metrics in colonoscopy is colorectal cancer incidence and mortality, but because of feasibility issues, a more readily accessible metric is the adenoma detection rate (ADR). Fourteen quality metrics were proposed by the joint American Society of Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on “Quality Indicators for Colonoscopy” in 2006, which are described in further detail below. Use of electronic health records and quality-oriented registries will facilitate quality measurement and reporting. Unlike traditional clinical research, implementation of quality improvement initiatives involves rapid assessments and changes on an iterative basis, and can be done at the individual, group, or facility level.

The ‘ins and outs’ of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit

“…Although some endoscopists challenge the association between withdrawal times and PDR/ADR (as increasing withdrawal time alone will not improve an ADR/PDR that is already adequate), data suggest that longer withdrawal times are strongly associated with an increase in PDR and ADR, particularly when endoscopists do not achieve accepted benchmarks. [1,13,19,21] Another factor that could have affected our PDR/ADR was the adequacy of our outpatient bowel preparation, which was below the ASGE/ACG Task Force benchmark of ≥85%. Interestingly, our results showed that inadequate bowel preparation yielded similar PDRs and ADRs to adequate bowel preparation, which could indicate that we are 'over-calling' poor bowel preparation as opposed to it actually being inadequate.…”

Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample

“…Adenoma detection rate (ADR) is the most validated measure of colonoscopy quality. [4] Lower physician ADR is associated with higher rates of interval colorectal cancer. [5] In a recent modeling study by Meester at al, a 5% decrease in ADR was associated with a 12.3% and 13.3% increase in colorectal cancer incidence and mortality, respectively.…”

A Review on the Quality of Colonoscopy Reporting

“…Quality reporting in colonoscopy is increasingly required to maintain public confidence. Health system management depends on metrics that are continually evaluated and associated with clinical outcomes and benchmarks [ 51 ]. Failure to allocate scarce resources based on access requirements and care quality can lead to misaligned incentives and poor outcomes.…”