کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3303592 1210318 2013 8 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیماری‌های گوارشی
پیش نمایش صفحه اول مقاله
Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance
چکیده انگلیسی

BackgroundEndoscopist quality is benchmarked by the adenoma detection rate (ADR)—the proportion of cases with 1 or more adenomas removed. However, the ADR rewards the same credit for 1 versus more than 1 adenoma.ObjectiveWe evaluated whether 2 endoscopist groups could have a similar ADR but detect significantly different total adenomas.DesignWe retrospectively measured the ADR and multiple measures of total adenoma yield, including a metric called ADR-Plus, the mean number of incremental adenomas after the first. We plotted ADR versus ADR-Plus to create 4 adenoma detection patterns: (1) optimal (↑ADR/↑ADR-Plus); (2) one and done (↑ADR/↓ADR-Plus); (3) all or none (↓ADR/↑ADR-Plus); (4) none and done (↓ADR/↓ADR-Plus).SettingTertiary-care teaching hospital and 3 nonteaching facilities servicing the same patient pool.PatientsA total of 3318 VA patients who underwent screening between 2005 and 2009.Main Outcome MeasurementsADR, mean total adenomas detected, advanced adenomas detected, ADR-Plus.ResultsThe ADR was 28.8% and 25.7% in the teaching (n = 1218) and nonteaching groups (n = 2100), respectively (P = .052). Although ADRs were relatively similar, the teaching site achieved 23.5%, 28.7%, and 29.5% higher mean total adenomas, advanced adenomas, and ADR-Plus versus nonteaching sites (P < .001). By coupling ADR with ADR-Plus, we identified more teaching endoscopists as optimal (57.1% vs 8.3%; P = .02), and more nonteaching endoscopists in the none and done category (42% vs 0%; P = .047).LimitationsExternal generalizability, nonrandomized study.ConclusionWe found minimal ADR differences between the 2 endoscopist groups, but substantial differences in total adenomas; the ADR missed this difference. Coupling the ADR with other total adenoma metrics (eg, ADR-Plus) provides a more comprehensive assessment of adenoma clearance; implementing both would better distinguish high- from low-performing endoscopists.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Gastrointestinal Endoscopy - Volume 77, Issue 1, January 2013, Pages 71–78
نویسندگان
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