Key performance measures for colonoscopy in the Polish Colonoscopy Screening Program

Abstract

Background The European Society of Gastrointestinal Endoscopy (ESGE) has published guidelines on key performance measures for colonoscopy. We analyzed whether those standards were met in the Polish Colonoscopy Screening Program (PCSP) and whether the monitoring was feasible. Methods We analyzed database records for 43 277 PCSP participants (25 PCSP centers) for the years 2014 – 2015. We used the guideline definitions to calculate values for all key performance measures and compared these with the proposed standards at individual, center, and program level. All data were acquired from the PCSP database, apart from complication data which was assessed from external registries. Results At the program level, four of five minimum standards and one of two target standards (no set minimum standard) were met. Adequate bowel preparation rate was 91.3 % for the whole program (range among individual centers 79.2 % – 99.2 %). Cecal intubation rate was 97.4 % (93.4 % – 99.4 %). Adenoma detection rate was 29.8 % (19.1 % – 39.1 %). An appropriate polypectomy technique was applied in 62.7 % of cases (0.4 % – 97.8 %). Regarding complications, 7-day hospitalization rate after screening colonoscopy was 0.3 % (n = 127), and 30-day all-cause mortality was 0.02 % (n = 9). Patient feedback was assessed in 66.2 % of colonoscopies (7.6 % – 81.8 %). Appropriate post-polypectomy surveillance was proposed in 95.4 % of cases (range 84.9 % – -99.7 %). It was easy to monitor 6 of 7 key performance measures within the PCSP database, but monitoring complications required the additional effort of data extraction from external registries. Conclusions The PCSP meets most proposed minimum standards at program level. Some centers need additional interventions to meet the complete set of quality standards. Use of ESGE performance measures for monitoring colonoscopy is generally feasible in the setting of the colonoscopy screening program.

Multi-step validation of a deep learning-based system for the quantification of bowel preparation: a prospective, observational study

“…21 Possible reasons for these variations in bowel preparation assessment include endoscopist skill level differences, heavy work load, inattention, and emotional factors. 13,14 Assistance from nurses when making assessments could help bias address these variations. However, a human rater cannot compensate for the inherent defects of subjective factors.…”

“…12 In clinical practice, inaccurate and missing bowel preparation recording could be attributed to multiple factors such as work load, shortage of supervision, and lacking practical tools. 13,14 Although studies have tried to introduce nurse raters to improve the quality of bowel assessment and reduce endoscopists' work load and bias introduced by endoscopists' assessments, the nurse raters cannot avoid the inherent defect of human rating. 15 Establishing practical and feasible methods to improve bowel preparation assessment in daily endoscopy is essential.…”

Colonoscopy quality: if you cannot measure it, you cannot improve it

“…The number of assessed indicators could be increased over time as registry implementation progresses. This is supported by the study of Bugajski et al, 10 which showed that collecting data on all 7 quality indicators endorsed by the European Society of Gastrointestinal Endoscopy was feasible 10 years after the introduction of quality assurance programs within the Polish Colonoscopy Screening Program.…”

“…A study by Greene et al, 9 who reviewed impediments encountered in matching colonoscopic and pathologic data in a New Hampshire population-based registry, showed that only 50% of polyps removed during screening and diagnostic colonoscopies were correctly matched with pathologic data with no assumption or discrepancy. Although the DGEA could calculate ADR for only 54% of the participating centers, and some other European screening colonoscopy registries showed more complete data, [10][11][12] the former used an automated system and the latter used manual data entry. Because manual matching of endoscopic and pathologic data is one of the major impediments to widespread and accurate measurement of ADR, 13 the introduction of an automated data extraction and analysis tool is a major achievement.…”

State of the Science on Quality Indicators for Colonoscopy and How to Achieve Them

“…Wallace et al demonstrated a significant improvement in ADR with multiple educational and system interventions, such as providing endoscopist report cards, education on how to achieve higher ADR and colon inspection techniques, and posting deidentified ADRs of physicians in the endoscopy unit (ADR 36%-47%; P , 0.001); these improvements were sustained 6 months later (83,84). Others have also demonstrated favorable improvements in polyp detection, adenoma detection, and WT with education and feedback that is sustained one year or longer (45,(85)(86)(87). For low performers, we recommend evaluation of withdrawal technique with emphasis on cleaning, suctioning, looking behind folds, and going back and forth during withdrawal.…”