Abstract
Quality metrics in colonoscopy are a growing area of focus given the development of and need for associated reporting and potential financial penalties. Three areas specifically have been identified as important by a multi-society task force, and the evidence behind each has been presented here. These metrics are adenoma detection rate, appropriate screening interval, and cecal intubation rate. Additional factors of interest include bowel preparation cleanliness and endoscope withdrawal time. Multifaceted interventions have been implemented to improve outcomes in colonoscopy with mixed success. Given that there are some quality metrics that have been shown to impact colorectal cancer outcomes, additional research should focus on disseminating these methods in a consistent and effective way across a myriad of practice models and patient populations.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Kerr E, McGlynn E, Adams J, et al. Profiling the Quality of Care in Twelve Communities: Results from the CQI Study. Health Aff. 2004;23:247–56.
American Cancer Society. Colorectal Cancer Facts & Figures 2011–2013. Atlanta: American Cancer Society; 2011.
Edwards B, Ward E, Kohler B, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–73.
Peery A, Dellon E, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–87.
Sonnenberg A, Amorosi S, Lacey M, Lieberman D. Patterns of endoscopy in the United States: analysis of data from the Centers for Medicare and Medicaid Services and the National Endoscopic Database. Gastrointest Endosc. 2008;67:489–96.
Rex D, Schoenfeld P, Cohen J, et al. Quality Indicators for GI Endoscopic Procedures. Am J Gastroenterol. 2015;110:72–90. This article by the ASGE and ACG task force identifies important quality indicators for colonoscopy and discusses the evidence behind such measures.
Corley D, Jensen C, Marks A, et al. Adenoma Detection Rate and Risk of Colorectal Cancer and Death. N Engl J Med. 2014;370:1298–306. In this study, ADR is shown to inversely correlate with the development of colorectal cancer.
Do A, Weinberg J, Kakkar A, Jacobson B. Reliability of adenoma detection rate is based on procedural volume. Gastrointest Endosc. 2013;77:376–80.
Williams J, Holub J, Faigel D. Polypectomy rate is a valid quality measure for colonoscopy: results from a national endoscopy database. Gastrointest Endosc. 2012;75:576–82.
Wang H, Pisegna J, Modi R, et al. Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance. Gastrointest Endosc. 2013;77:71–8.
Kahi C, Vemulapalli K, Johnson C, Rex D. Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric: the Indiana University experience. Gastrointest Endosc. 2014;79:448–54.
Goodwin J, Singh A, Reddy N, et al. Overuse of Screening Colonoscopy in the Medicare Population. Arch Intern Med. 2011;171(15):1335–43.
Van Rijn J, Reitsma J, Stoker J, et al. Polyp Miss Rate Determined by Tandem Colonoscopy: A Systematic Review. Am J Gastroenterol. 2006;101:343–50.
Sammader N, Curtin K, Tuohy T, et al. Characteristics of Missed or Interval Colorectal Cancer and Patient Survival: A Population-Based Study. Gastroenterology. 2014;146:950–60.
Iskandar H, Yan Y, Elwing J, et al. Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines. Dig Dis Sci. 2015;60:971–8.
Bonta, C. Summit Health Care Consulting. ASGE Presentation. “2015 PQRS Requirements: What Eligible Professionals Need to Know to Avoid the PQRS Penalty in 2017.” Available at http://www.asge.org/uploadedFiles/Members/Advocacy/Regulations/ASGE%20PQRS%20Presentation_Final_12-8-2014.pdf
Baxter N, Sutradhar R, Forbes S. Analysis of Administrative Data Finds Endoscopist Quality Measures Associated With Postcolonoscopy Colorectal Cancer. Gastroenterology. 2011;140:65–72.
Calderwood A, Jacobson B. Comprehensive validation of the Boston Bowel Preparation Scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009;69:620–5.
Menees S. The impact of fair colonoscopy preparation on colonoscopy use and adenoma miss rates in patients undergoing outpatient colonoscopy. Gastrointest Endosc. 2013;78:510–6.
Chokshi R, Hovis C, Hollander T, et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc. 2012;75:1197–203.
Harewood G, Sharma V, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–9.
Gurudu S, Ramirez F, Harrison M, et al. Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy. Gastrointest Endosc. 2012;76:603–608.e1.
Bucci C, Rotondano G, Rea M, et al. Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc. 2014;80:566–576.e2. This review of 29 studies spanning over 50 years shows that a higher percentage of patients achieve adequate bowel preparation with split-dose than with non-split-dose preparations.
Martel M, Barkun A, Menard C, et al. Split-Dose Preparations are Superior to Day-before Bowel Cleansing Regimens: A Meta-analysis. Gastroenterology. Available Online April 8, 2015. In Press, Accepted Manuscript.
Lee T, Blanks R, Rees C. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy. 2013;45:20–6.
Corley D, Jensen C, Marks A. Can we improve adenoma detection rates? A systematic review of intervention studies. Gastrointest Endosc. 2011;74:656–66.
Bechtold M, Perez R, Puli S, Marshall J. Effect of music on patients undergoing outpatient colonoscopy. World J Gastroenterol. 2006;12:7309–12.
Lin O, Kozarek R, Arai A, et al. The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores. Gastrointest Endosc. 2010;71:1253–9.
Centers for Disease Control. CDC Statement: Los Angeles Country/UCLA Investigation of CRE transmission of duodenoscopes. Available at: http://www.cdc.gov/hai/outbreaks/cdcstatement-LA-CRE.html. Page last updated: February 20, 2015.
Fisher D, Maple J, Ben-Menachem T, et al. Guideline: Complications of Colonoscopy. Gastrointest Endosc. 2011;74:745–52.
Calderwood A, Chapman F, Cohen J, et al. Guidelines for Safety in the Gastrointestinal Endoscopy Unit. Gastrointest Endosc. 2014;79:363–72.
Petersen B. Quality Improvement for the Ambulatory Surgery Center. Clin Gastroenterol Hepatol. 2014;12:911–8.
Logan J, Lieberman D. The Use of Databases and Registries to Enhance Colonoscopy Quality. Gastrointest Endosc Clin N Am. 2010;20:717–34.
Kaminski M, Anderson J, Valori R, et al. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut gutjnl-2014-307503 Published Online First: 10 February 2015 doi:10.1136/gutjnl-2014-307503.
Kahi C, Ballard D, Shah A, et al. Impact of a quarterly report card on colonoscopy quality measures. Gastrointest Endosc. 2013;77:925–30. A quality report card was shown to improve adjusted adenoma detection and cecal intubation rates.
Shaukat A, Oancea C, Bond J, et al. Variation in Detection of Adenomas and Polyps by Colonoscopy and Change Over Time With a Performance Improvement Program. Clin Gastroenterol Hepatol. 2009;7:1335–40.
Calderwood A, Lai E, Fix O, Jacobson B. An endoscopist-blinded, randomized, controlled trial of a simple visual aid to improve bowel preparation for screening colonoscopy. Gastrointest Endosc. 2011;73:307–14.
Tae J, Lee J, Hong S, et al. Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy. Gastrointest Endosc. 2012;76:804–11. The use of a cartoon to guide patients in bowel preparation resulted in improved Boston Bowel Preparation Scores.
Spiegel B, Talley J, Shekelle P, et al. Development and Validation of a Novel Patient Educational Booklet to Enhance Colonoscopy Preparation. Am J Gastroenterol. 2011;106:875–83.
Lee A, Vu M, Fisher D, et al. Further validation of a novel patient educational booklet to enhance colonoscopy preparation: benefits in single-dose, but not split-dose preparations. Gastroenterology. 2013;144:S191.
Thirumurthi S, Ross W, Lum P, et al. When patients watch a video, physicians see more adenomas: An educational bowel preparation video improves adenomas detection rates. Gastrointest Endosc. 2015;81:AB228–9.
Colonoscopy Prep Assistant. Medivo, Inc. Available at: https://itunes.apple.com/us/app/colonoscopy-prep-assistant/id413055762?mtZ8. Accessed May 23, 2015.
Sawhney R, Cury M, Neeman N, et al. Effect of Institution-Wide Policy of Colonoscopy Withdrawal Time ≥7 Minutes on Polyp Detection. Gastroenterology. 2008;135:1892–8.
Taber A, Romagnuolo J. Effect of simply recording colonoscopy withdrawal time on polyp and adenoma detection rates. Gastrointest Endosc. 2010;71:782–6.
Hewett D, Rex D. Improving Colonoscopy Quality Through Health-Care Payment Reform. Am J Gastroenterol. 2010;105:1925–33.
Gimeno-García A, Quintero E. Colonoscopy appropriateness: Really needed or a waste of time? World J Gastrointest Endosc. 2015;7:94–101.
Hassan C, Gralnek I. Cost-effectiveness of “full spectrum endoscopy” colonoscopy for colorectal cancer screening. Digestive and Liver Disease. Available online 2 February 2015.
Compliance with Ethics Guidelines
Conflict of Interest
Katherine T. Brunner and Audrey H. Calderwood declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Large Intestine
Rights and permissions
About this article
Cite this article
Brunner, K.T., Calderwood, A.H. Quality in Colonoscopy. Curr Gastroenterol Rep 17, 38 (2015). https://doi.org/10.1007/s11894-015-0461-1
Published:
DOI: https://doi.org/10.1007/s11894-015-0461-1