Issue: July 25, 2013
June 25, 2013
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Report card improved adenoma detection, cecal intubation rate during colonoscopy

Issue: July 25, 2013
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Colonoscopies administered after the introduction of a quarterly report card assessing procedure quality had improved cecal intubation and adenoma detection rates compared to pre-intervention procedures in a recent study.

In a retrospective review, researchers evaluated data from 928 patients aged 50 years or older who underwent their first screening colonoscopy within at least 5 years at Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis. In 2009, the facility introduced a quarterly report card for physicians performing endoscopic procedures, which include information on bowel preparation quality, patient assessment, adenoma detection rates (ADR), cecal intubation and withdrawal time for each patient.

The cohort included 592 patients screened between April 1, 2009 and March 31, 2011, after the introduction of the report card intervention, and 336 screened between July 1, 2008 and Dec. 31, 2008, before intervention. Procedures were performed by six endoscopists.

Patients screened during the intervention phase had higher ADR (53.9% vs. 44.7%; P=.013) and cecal intubation rates (98.1% vs. 95.6%; P=.027) than those screened before report cards began. Detection of proximal adenomas was higher post-intervention (39.8% vs. 29.3%; P=.003); no significant difference was observed in detection of distal adenomas, advanced neoplasms or serrated polyps. The number of adenomas detected per colonoscopy and mean adenoma size also did not differ significantly throughout the study.

Multivariate analysis indicated significant associations between ADR and the report card intervention (OR=1.45; 95% CI, 1.08-1.94), advanced age (OR=1.36; 95% CI, 1.12-1.65 per 10 years) and male sex (OR=2.09; 95% CI, 1.21-3.64).

“A quarterly report card was associated with improved colonoscopy quality indicators,” the researchers concluded. “This intervention is practical to generate and implement, and it may serve as a model for quality improvement programs in different patient and physician groups. Additional work is needed to determine whether this intervention is effective in different practice settings and its beneficial effects sustained.”

Disclosure: The study was supported in part by the Cordelia Collins Research Fund.