Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance - 20/12/12
Reprint requests: Brennan M.R. Spiegel, MD, MSHS, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, UCLA/VA Center for Outcomes Research and Education (CORE), 11301 Wilshire Blvd., Bldg. 115, Room 215, Los Angeles, CA 90073Résumé |
Background |
Endoscopist 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.
Objective |
We evaluated whether 2 endoscopist groups could have a similar ADR but detect significantly different total adenomas.
Design |
We 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).
Setting |
Tertiary-care teaching hospital and 3 nonteaching facilities servicing the same patient pool.
Patients |
A total of 3318 VA patients who underwent screening between 2005 and 2009.
Main Outcome Measurements |
ADR, mean total adenomas detected, advanced adenomas detected, ADR-Plus.
Results |
The 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).
Limitations |
External generalizability, nonrandomized study.
Conclusion |
We 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.
Le texte complet de cet article est disponible en PDF.Abbreviations : ADR, WLAVA, CRC
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This research was supported by a Veterans Affairs Merit Award (IIR 08-310) to Dr Spiegel and an NIH training grant (T32DK07180-34) to Dr Wang. |
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| See CME section; p. 108. |
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| The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs. |
Vol 77 - N° 1
P. 71-78 - janvier 2013 Retour au numéro
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