Original articleClinical endoscopyMeasurement of polypectomy rate by using administrative claims data with validation against the adenoma detection rate
Section snippets
Background
Many quality measures have been proposed for colonoscopy to try to maximize preventive benefits. The most important of these has been the adenoma detection rate (ADR), which is the proportion of screening colonoscopies in which at least one adenoma is identified. In a previous study, the ADR of an endoscopist was inversely associated with the risk of interval colorectal cancer developing in the patients of that endoscopist.8 Measuring ADR has thus become a priority, and benchmarks for screening
Methods
We conducted a retrospective study of outpatient colonoscopies performed at Mayo Clinic, Scottsdale, Arizona, between January 1, 2009 and December 31, 2009. Electronic medical records were reviewed for all patients who underwent outpatient colonoscopies during the study period. Endoscopists reported all colonoscopy findings by using a standard computerized endoscopy report generator (Mayo Electronic Record for Gastrointestinal Endoscopy [MERGE]). Repeat colonoscopies in the same patient during
Results
A total of 5382 colonoscopy reports were reviewed, as were the pathology reports corresponding to each procedure. A total of 19 endoscopists met the 50-procedure minimum inclusion criterion. Of these 19, most (16 endoscopists) were attending gastroenterologists; 3 were attending colorectal surgeons. The mean number of colonoscopies performed by each endoscopist was 275 (range 63-527).
Table 1 summarizes the characteristics of the patients who underwent colonoscopy. The mean (± standard deviation
Discussion
Colonoscopy is the primary method of screening for colorectal cancer in the United States. Although it represents a cost-effective means of screening for colorectal neoplasia, colonoscopy still constitutes an invasive screening examination with inherent costs and risks.13 For this reason, it is imperative to focus on the quality of colorectal cancer screening and surveillance received from colonoscopy. Doing so has become a major point of emphasis for organizations such as the American Society
References (16)
- et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Gastroenterology
(2008) - et al.
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies
Gastroenterology
(1997) - et al.
Variation in polyp detection rates at screening colonoscopy
Gastrointest Endosc
(2009) - et al.
Quality indicators for colonoscopy
Gastrointest Endosc
(2006) Less stick, more carrot: measuring and improving patient satisfaction with endoscopic procedures
Gastrointest Endosc
(2009)- et al.
Polypectomy rate as a quality measure for colonoscopy
Gastrointest Endosc
(2011) - et al.
Polypectomy rate is a valid quality measure for colonoscopy: results from a national endoscopy database
Gastrointest Endosc
(2012) - et al.
Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate
Gastrointest Endosc
(2011)
Cited by (36)
Comparison of Quality Measures for Detection of Neoplasia at Screening Colonoscopy
2023, Clinical Gastroenterology and HepatologyCitation Excerpt :The date of the screening colonoscopy was regarded as the beginning of the follow-up time. To analyze CRC incidence, we counted only CRCs that were diagnosed between at least 6 months after screening colonoscopy and recommended surveillance, ie, within 5 years of follow-up if a patient was diagnosed with low-risk adenoma and within 3 years if a patient was diagnosed with high-risk adenoma.18 For patients diagnosed with no adenomas, we counted only CRCs diagnosed within 10 years of follow-up.
Adenoma detection rate and risk of colorectal cancer
2017, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Since ADR measurement requires merging histopathological databases with endoscopic ones, there is also call for a more feasible quality indicator that can be used as ADR surrogate. It has been shown, that PDR may be used to estimate ADR [40,41]. PDR is easy to calculate and monitor, however it is prone to gaming, because lymphoid nodules or even protrusions of normal mucosa could be mistakenly taken for polyps.
Adenoma detection rate: In search of quality improvement, not just measurement
2015, Gastrointestinal EndoscopyNatural language processing as an alternative to manual reporting of colonoscopy quality metrics
2015, Gastrointestinal EndoscopyCitation Excerpt :In our study, endoscopists manually extracted the records for internal audit for approximately 5 minutes per record entry after reviewing the endoscopy and pathology records as well as looking at past medical records. Because of these challenges in calculating the ADR, some centers have resorted to calculation of the polypectomy rate using administrative claims data, which has proven to be an accurate surrogate for the ADR in preliminary reports and may become an important quality measure for external and internal use.11 However, the polypectomy rate is perceived by the endoscopy community to be set up for potential misuse by endoscopists if they remove normal tissue or non-neoplastic polyps and report these resections as polypectomies.
Nonneoplastic polypectomy during screening colonoscopy: The impact on polyp detection rate, adenoma detection rate, and overall cost
2015, Gastrointestinal EndoscopyCitation Excerpt :Either a board certified gastroenterologist or gastroenterology fellow under the direct supervision of an attending physician was included; colorectal surgeons were excluded. Historical data of our endoscopists from 2009 indicated that the PDR range was 27% to 55%, and the ADR range was 16% to 38%.18 All physicians are salaried and without incentive for number of procedures completed and/or polypectomy.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.