Original article
Clinical endoscopy
Measurement of polypectomy rate by using administrative claims data with validation against the adenoma detection rate

Presented at the American Society of Gastroenterology, Presidential Plenary Session, May 21, 2012, San Diego, California.
https://doi.org/10.1016/j.gie.2012.09.032Get rights and content

Background

The adenoma detection rate (ADR) is a main quality indicator in colonoscopy but has many challenges for calculating. The polypectomy rate (PR) may be calculable from administrative claims data, but this has not been validated against the ADR.

Objective

To determine whether a PR calculated from United States billing claims data is an accurate surrogate for the ADR.

Design

A PR was calculated by using billing claims data from Current Procedural Terminology codes. The ADR was calculated for each endoscopist by using an endoscopy report database to which the pathology report data had been added. The relationship between PR and ADR was evaluated with the Pearson correlation coefficient. The ADR was plotted against the PR by individual endoscopist, and a least-squares regression line was created. A t test was used to analyze the differences in lesion detection between endoscopists with a PR above and below the benchmark PR.

Setting

Tertiary-care, outpatient endoscopy center.

Patients

All ages undergoing colonoscopy.

Main Outcome Measurements

PR and ADR.

Results

A total of 5382 colonoscopies were reviewed. A significant relationship between endoscopists' calculated PRs and ADRs was seen (r = 0.85; P < .001). Endoscopists needed a PR of 35% to achieve the recommended benchmark ADR of 20%. Endoscopists with PRs of 35% or greater had an ADR of 27% (6.2 standard deviation [SD]) as compared with 19% (1.9 SD) for those with PRs less than 35% (P = .0029).

Limitations

Study population.

Conclusion

Calculated PR from billing claims data is an accurate surrogate for ADR and may become an important quality measure for external and internal use.

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

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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