Measurement of polypectomy rate by using administrative claims data with validation against the adenoma detection rate

Patel, Niren; Islam, Rafiul; Wu, Qing; Gurudu, Suryakanth R.; Ramirez, Francisco C.; Crowell, Michael D.; Faigel, Douglas O.

doi:10.1016/j.gie.2012.09.032

Cited by 41 publications

(23 citation statements)

References 16 publications

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“…PDR was proposed in many studies as a surrogate for ADR and can be considered one of the quality measures in colonoscopy. 8,9 These studies demonstrate that both PDR and ADR are well correlated through the entire colon, which was confirmed in our study as well. However, one of the major drawbacks of using the PDR as a quality indicator is the risk of the endoscopist gaming the system by artificially increasing the removal rates of small and clinically insignificant polyps, which may lead to additional cost and possibly more procedure complications.…”

Section: Discussionsupporting

confidence: 90%

“…Recently, several studies reported the positive correlation between ADR and PDR and suggested the use of PDR as surrogate marker for ADR, and hence it could be used as one of the colonoscopy quality indicators. 8,9 Francis et al 10 proposed a conversion factor that can be used to accurately estimate ADR for individual endoscopists from the PDR. The proposed conversion factor utilizes the average adenoma to polyp detection rate quotient (APDRQ) of the practice to calculate a conversion factor that can accurately predict ADR.…”

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confidence: 99%

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Estimation of the Adenoma Detection Rate From the Polyp Detection Rate by Using a Conversion Factor in a Predominantly Hispanic Population

Elhanafi¹,

Ortiz²,

Yarlagadda³

et al. 2015

Journal of Clinical Gastroenterology

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Estimation of the Adenoma Detection Rate From the Polyp Detection Rate by Using a Conversion Factor in a Predominantly Hispanic Population

Elhanafi¹,

Ortiz²,

Yarlagadda³

et al. 2015

Journal of Clinical Gastroenterology

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“…PDR values have been shown to be highly correlated (r>0.80) with ADR. (24–27) PDRs were calculated for each physician by dividing the number of patients on whom polypectomy was performed by the total number colonoscopies performed during a 5-year period and ranked into quartiles (outlined in Appendix Table 2). A patient was assigned their physician’s PDR in the 5-year period preceding the index colonoscopy.…”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence

et al. 2017

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Background Interval colorectal cancers (CRC) account for 3–8% of all CRCs in the US. Data on interval CRC occurrence by race/ethnicity are scant. Objective To examine whether interval CRC risk among Medicare patients differs by race/ethnicity and whether this potential variation, could be accounted for by differences in quality of colonoscopy, as measured by physicians’ polyp detection rate (PDR). Design, Setting and Participants Population-based cohort study of patients 66–75 years who received a colonoscopy between 2002–2011 in SEER-Medicare data. Measurements Kaplan-Meier curves and adjusted Cox models were used to estimate cumulative probabilities and hazard ratios (HR) of interval CRCs, defined as a CRC diagnosis 6–59 months after colonoscopy. Results There were 2,735 interval CRCs identified over 235,146 person-years of follow-up. A higher proportion of blacks (52.8%) received colonoscopy from physicians with lower PDR than whites (46.2%). PDR was significantly associated with interval CRC risk. The probability of interval CRC by the end of follow-up was 7.1% in blacks and 5.8% in whites. Compared to whites, blacks had significantly higher interval CRC risk (HR= 1.31, 95% CI 1.13, 1.51), the disparity was more pronounced for cancers in the rectum (HR=1.70, 95% CI 1.25, 2.31) and distal (HR=1.45, 95% CI 1.00, 2.11) than in the proximal (HR=1.17, 95% CI 0.96, 1.42) colon. Adjustment for polyp detection rate did not alter HRs by race/ethnicity, but black-white differences were greater among physicians with higher polyp detection rates. Limitations Colonoscopy and polypectomy were identified using billing codes. Conclusions Among elderly Medicare enrollees, interval CRC risk was higher in blacks than in whites, with the difference more pronounced for distal colon/rectum cancers and for physicians with higher polyp detection rates. Primary Funding Source The American Cancer Society.

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“…However, ADR is difficult to assess using population-based data due to the lack of pathology report information in health administrative databases. Polypectomy rate, the proportion of colonoscopies that result in the removal of one or more polyps, has been proposed as an alternative quality indicator because it is known at the time of colonoscopy, strongly correlated with ADR, and available from health administrative data [12-14]. Quality benchmarks for polypectomy rates have been proposed [12,14].…”

Section: Introductionmentioning

confidence: 99%

Endoscopist specialty is associated with colonoscopy quality

et al. 2013

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BackgroundSome studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps.MethodsA cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50–75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy.ResultsIn total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32–0.71) in Montreal and 0.73 (95% CI: 0.43–1.21) in Calgary.ConclusionsAn association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.

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Measurement of polypectomy rate by using administrative claims data with validation against the adenoma detection rate

Cited by 41 publications

References 16 publications

Estimation of the Adenoma Detection Rate From the Polyp Detection Rate by Using a Conversion Factor in a Predominantly Hispanic Population

Estimation of the Adenoma Detection Rate From the Polyp Detection Rate by Using a Conversion Factor in a Predominantly Hispanic Population

Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence

Endoscopist specialty is associated with colonoscopy quality

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