Impact of feedback on adenoma detection rates: Outcomes of quality improvement program

Feedback has been shown to improve performance in colonoscopy including adenoma detection rate (ADR). The frequency at which feedback should be given is unknown. As part of a quality improvement program, we sought to measure the outcome of providing quarterly and monthly feedback on colonoscopy quality measures.

All screening colonoscopies performed at endoscopy unit at Mayo Clinic Arizona by gastroenterologists between October 2010 and December 2012 were reviewed. Quality indicators, including ADR, were extracted for each individual endoscopist, and feedback was provided. The study period was divided into four distinct groups: pre-intervention that served as baseline, quarterly feedback, monthly feedback, and post-intervention. Based on ADR, endoscopists were grouped into "low detectors" (≤ 25%), "average detectors" (26-35%), and "high detectors" (> 35%).

A total of 3420 screening colonoscopies were performed during the study period (555 patients during pre-intervention, 1209 patients during quarterly feedback, 599 during monthly feedback, and 1057 during the post-intervention period) by 16 gastroenterologists. The overall ADR for the group improved from 30.5% to 37.7% (P = 0.003). Compared with the pre-interventional period, all quality indicators measured significantly improved during the monthly feedback and post-intervention periods but not in the quarterly feedback period.

In our quality improvement program, monthly feedback significantly improved colonoscopy quality measures, including ADR, while quarterly feedback did not. The impact of the intervention was most prominent in the "low detectors" group. Results were durable up to 6 months following the intervention.