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Polypectomy rate is a valid quality measure for colonoscopy: results from a national endoscopy database
Jason E Williams1, Jennifer L Holub, Douglas O Faigel
1Division of Gastroenterology, Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128, USA.
Background:
The adenoma detection rate (ADR) is one of the main quality measures for colonoscopy, but it is burdensome to calculate and is not amenable to claims-based reporting.
Objective:
To validate the correlation between polypectomy rates (PRs) and ADRs by using a large group of endoscopists.
Design:
Retrospective study.
Setting:
Community and academic endoscopy units in the United States.
Subjects:
Sixty endoscopists and their patients.
Main Outcome Measurements:
Proportion of patients with any adenoma and any polyp removed; correlation between ADRs and PRs.
Results:
In total, 14,341 screening colonoscopies were included, and there was high correlation between endoscopists' PRs and ADRs in men ( r(s)= .91, P < .0001) and women (r(s) = .91, P < .0001). Endoscopists with PRs in the highest quartile had a significantly higher ADR than did those in the lowest quartile in men (44.6% vs 19.4%, P < .0001) and women (33.6% vs 11.6%, P < .0001). Endoscopists in the top polypectomy quartile also found more advanced adenomas than did endoscopists in the bottom quartile (men: 9.6% vs 4.6%, P = .0006; women: 6.3% vs 3.0%, P = .01). Benchmark PRs of 40% and 30% correlated with ADRs greater than 25% and 15% for men and women, respectively.
Limitation:
Retrospective analysis of a subset of a national endoscopic database.
Conclusions:
Endoscopists' PRs correlate well with their ADRs. Given its clinical relevance, its simplicity, and the ease with which it can be incorporated into claims-based reporting programs, the PR may become an important quality measure.
