Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group

BackgroundThere is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level.ObjectiveTo evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation.DesignObservational cross-sectional analysis.SettingCollaborative quality metrics database from 2007 to 2012.PatientsPatients who underwent colonoscopies in ambulatory surgery centers.InterventionsColonoscopy.Main Outcome MeasurementsThe number of colonoscopies with an adenomatous polyp divided by the total number of colonoscopies (ADR-T), inclusive of indication and patient's sex.ResultsData from 368,157 colonoscopies were included for analysis from 11 practices. Three practice sites (5, 8, and 10) were significantly above and 2 sites (3, 7) were significantly below mean ADR-T, with a 95% confidence interval (CI). High-performing sites had 9.0% higher ADR-T than sites belonging to the lowest quartile (P < .001). The mean ADR-T remained stable for 9 of 11 sites. Regression analysis showed that the 2 practice sites where ADR-T varied had significant improvements in ADR-T during the 6-year period. For each, mean ADR-T improved an average of 0.5% per quarter for site 2 (P = .001) and site 3 (P = .021), which were average and low performers, respectively.LimitationsSummary-level data, which does not allow cross-reference of variables at an individual level.ConclusionWe found performance disparities among practice sites remaining relatively consistent over a 6-year period. The ability of certain sites to sustain their high-performance over 6 years suggests that further research is needed to identify key organizational processes and physician incentives that improve the quality of colonoscopy.