There is marked variability in colonoscopy quality, limiting its effectiveness in colorectal cancer prevention. Multiple indicators have been established as markers for colonoscopy quality; however, there are conflicting data on the effects of quality reporting programs on endoscopist performance. In this study, we investigate the impact of a multicenter quarterly report card initiative on colonoscopy quality metric performance.
Data were collected from 194 endoscopists at 10 participating sites throughout New York City using a Qualified Clinical Data Registry from January 2013 to December 2014. Adenoma detection rate (ADR), cecal intubation rate, withdrawal time, bowel preparation quality and appropriate interval recommendations were tracked. Report cards were distributed to each site on a quarterly basis and technical assistance was provided as needed. Performance trends were analyzed using the Cochran–Armitage trend and analysis of variance tests.
37,258 screening colonoscopies were performed during the study period. There was a positive performance trend for ADR over time from the first quarter of 2013 to the last quarter of 2014 (15.6–25.7%; p < 0.001). There were also increases in cecal intubation rates (78.2–92.6%; p < 0.001), bowel preparation adequacy rates (77.5–92.8%; p < 0.001), and adherence to appropriate screening intervals (28.0–55.0%; p < 0.001). There was no clinically significant change in mean withdrawal time.
The implementation of a quarterly report card initiative resulted in statistically significant improvements in adenoma detection, cecal intubation, bowel preparation adequacy rates, and appropriate recommended screening intervals.
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Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34.
Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA. 2006;295:2366–2373.
Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–168.
Lieberman DA, Weiss DG. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med. 2001;345:555–560.
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981.
Zauber AG, Winawer SJ, O’brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.
Kahi CJ, Imperiale TF, Juliar BE, Rex DK. Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol. 2009;7:770–775.
Singh S, Singh PP, Murad MH, Singh H, Samadder NJ. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109:1375–1389.
Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014;63:949–956.
Van rijn JC, Reitsma JB, Stoker J, Bossuyt PM, Van deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–350.
Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.
Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–1306.
Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology. 2011;140:65–72.
Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–2541.
Lebwohl B, Kastrinos F, Glick M, Rosenbaum AJ, Wang T, Neugut AI. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011;73:1207–1214.
Harewood GC, Sharma VK, De garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–79.
Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.
Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97:1296–1308.
Corley DA, Jensen CD, Marks AR. Can we improve adenoma detection rates? A systematic review of intervention studies. Gastrointest Endosc. 2011;74:656–665.
Kahi CJ, Ballard D, Shah AS, Mears R, Johnson CS. Impact of a quarterly report card on colonoscopy quality measures. Gastrointest Endosc. 2013;77:925–931.
Inra JA, Nayor J, Rosenblatt M, et al. Comparison of colonoscopy quality measures across various practice settings and the impact of performance scorecards. Dig Dis Sci. 2017;62:894–902. https://doi.org/10.1007/s10620-016-4410-0.
Keswani RN, Yadlapati R, Gleason KM, et al. Physician report cards and implementing standards of practice are both significantly associated with improved screening colonoscopy quality. Am J Gastroenterol. 2015;110:1134–1139.
Abdul-baki H, Schoen RE, Dean K, et al. Public reporting of colonoscopy quality is associated with an increase in endoscopist adenoma detection rate. Gastrointest Endosc. 2015;82:676–682.
Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:856–861.
Sanchez W, Harewood GC, Petersen BT. Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. Am J Gastroenterol. 2004;99:1941–1945.
Uche-anya EN, Decuir N, Lebwohl B. Temporal trends and risk factors for postcolonoscopy colorectal cancer. J Clin Gastroenterol. 2018;53:e334–e340.
Murthy SK, Benchimol EI, Tinmouth J, et al. Temporal trends in postcolonoscopy colorectal cancer rates in 50- to 74-year-old persons: a population-based study. Gastrointest Endosc. 2018;87:1324–1334.e4.
Itzkowitz SH, Winawer SJ, Krauskopf M, et al. New York citywide colon cancer control coalition: a public health effort to increase colon cancer screening and address health disparities. Cancer. 2016;122:269–277.
New York City Department of Health and Mental Hygiene. Epiquery: NYC Interactive Health Data System—Community Health Survey 2003–2017. 2019. https://nyc.gov/health/epiquery.
Coe SG, Crook JE, Diehl NN, Wallace MB. An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol. 2013;108:219–226.
Ussui V, Coe S, Rizk C, Crook JE, Diehl NN, Wallace MB. Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II. Am J Gastroenterol. 2015;110:489–496.
Wallace MB, Crook JE, Thomas CS, Staggs E, Parker L, Rex DK. Effect of an endoscopic quality improvement program on adenoma detection rates: a multicenter cluster-randomized controlled trial in a clinical practice setting (EQUIP-3). Gastrointest Endosc. 2017;85:538–545.e4.
Kaminski MF, Anderson J, Valori R, et al. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut. 2016;65:616–624.
Richards CA, Kerker BD, Thorpe L, et al. Increased screening colonoscopy rates and reduced racial disparities in the New York Citywide campaign: an urban model. Am J Gastroenterol. 2011;106:1880–1886. https://doi.org/10.1038/ajg.2011.191.
This initiative was supported by the Centers for Disease Control: IU58DP0000783.
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Uche-Anya, E.N., Brown, J.J., Asumeng, C. et al. Impact of a Citywide Benchmarking Intervention on Colonoscopy Quality Performance. Dig Dis Sci (2020). https://doi.org/10.1007/s10620-020-06067-y
- Colorectal cancer screening
- Colonoscopy quality
- Colon cancer prevention