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Physician report cards, standards of practice improve colonoscopy quality
The distribution of colonoscopy quality report cards to physicians and implementation of standards of practice were associated with improved adenoma detection rates, according to recent study data.
“While there is now an abundance of high-quality literature that clearly associates high adenoma detection rates (ADRs) with lower risks of interval colon cancer, comparatively little is known about how to improve individual physician ADRs,” Rajesh N. Keswani, MD, of the division of gastroenterology at Northwestern University Feinberg School of Medicine, told Healio Gastroenterology. “We demonstrated in a large group of endoscopists with diverse baseline ADRs that feedback, in the form of report cards, significantly improves colonoscopy quality. Moreover, we found that when our institution additionally mandated a minimal practice standard, requiring that all physicians achieve a minimal ADR (20%), our endoscopy center’s overall ADR significantly improved beyond the effect of a report card.”
Rajesh N. Keswani
John E. Pandolfino
Keswani, John E. Pandolfino, MD, also from Northwestern, and colleagues conducted a prospective cohort study of 20 endoscopists who performed at least 15 colonoscopies per month (12,894 total) during a 23-month period. In the first phase, beginning in April 2013, the first colonoscopy quality report cards with information on endoscopist and institutional ADRs and withdrawal times were generated by an electronic data warehouse and distributed to each endoscopist. In the second phase, a multidisciplinary group developed institutional standards of practice that established a minimum recommended withdrawal time of 5 minutes and a minimum ADR of 20%, and in April 2014 these standards of practice were distributed to each endoscopist along with a second report card. Endoscopists were informed that failure to meet benchmarks would result in further training or altered endoscopy block times.
Endoscopist and institutional mean ADRs and withdrawal times were measured at baseline (November 2012 – March 2013), after the first report cards were distributed (April 2013 – March 2014) and after the second report cards were distributed and the standards of practice were implemented (April 2014 – October 2014). After the first cards were distributed, mean ADR increased by 3% (95% CI, 1.6-5). After the standards of practice were implemented, mean ADR increased further by 8% (95% CI, 5.4-10.5), resulting in an overall absolute increase in ADR of 11% (95% CI, 9-13.5). All physicians met the minimum benchmarks after the standards of practice were implemented. Overall, ADRs were correlated with withdrawal time (P = .04), but mean withdrawal time did not significantly increase.
“All individual physician ADRs exceeded 20% after implementation of feedback and standards of practice, without the need for retraining, compared to 80% prior to report card distribution,” Keswani said. “These findings stress the critical importance that medical leadership, by setting expectations that all physicians practice at a certain quality level, can have in quality improvement.” – by Adam Leitenberger
Disclosure: Keswani reports he is a consultant for Boston Scientific and Cook Medical.