Assessment of the quality of colonoscopy reports: results from a multicenter consortium
Background
To improve colonoscopy quality, reports must include key quality indicators that can be monitored.
Objective
To determine the quality of colonoscopy reports in diverse practice settings.
Setting
The consortium of the Clinical Outcomes Research Initiative, which includes 73 U.S. gastroenterology practice sites that use a structured computerized endoscopy report generator, which includes fields for specific quality indicators.
Design
Prospective data collection from 2004 to 2006.
Main Outcomes Measurements
Reports were queried to determine if specific quality indicators were recorded. Specific end points, including quality of bowel preparation, cecal intubation rate, and detection of polyp(s) >9 mm in screening examinations were compared for 53 practices with more than 100 colonoscopy procedures per year.
Results
Of the 438,521 reports received during the study period, 13.9% did not include bowel-preparation quality and 10.1% did not include comorbidity classification. The overall cecal intubation rate was 96.3%, but cecal landmarks were not recorded in 14% of the reports. Missing polyp descriptors included polyp size (4.9%) and morphology (14.7%). Reporting interventions for adverse events during the procedure varied from 0% to 6.5%. Among average-risk patients who received screening examinations, the detection rate of polyps >9 mm, adjusted for age, sex, and race, was between 4% and 10% in 81% of practices.
Limitation
Bias toward high rates of reporting because of the standard use of a computerized report generator.
Conclusions
There is significant variation in the quality of colonoscopy reports across diverse practices, despite the use of a computerized report generator. Measurement of quality indicators in clinical practice can identify areas for quality improvement.
Abbreviations: ASA, American Society of Anesthesiology classification, CO-RADS, Colonoscopy Reporting and Data System, CORI, Clinical Outcomes Research Initiative, CORI-NED, CORI National Endoscopic Database, CRC, colorectal cancer, FOBT, fecal occult blood test, MSTF-CRC, Multi-Society Task Force on Colorectal Cancer, VA, Veterans Affairs
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This project was supported with funding from NIDDK UO1 DK57132, the American Cancer Society and the Centers for Disease Control and Prevention. In addition, the practice network (CORI) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. D. Lieberman is the executive director of the CORI, a nonprofit organization that receives funding from federal and industry sources. The CORI database was used in this study. This relationship has been reviewed and managed by the OHSU Conflict of Interest in Research Committee and the VA Conflict of Interest in Research Committee. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Reprint requests: Reprints are not available from the authors.
If you want to chat with an author of this article, you may contact him at lieberma@ohsu.edu.
PII: S0016-5107(08)02494-2
doi:10.1016/j.gie.2008.08.034
© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
