title: Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group.
abstract: BACKGROUND
  There is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level.
  
  
  OBJECTIVE
  To evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation.
  
  
  METHODS
  Observational cross-sectional analysis.
  
  
  METHODS
  Collaborative quality metrics database from 2007 to 2012.
  
  
  METHODS
  Patients who underwent colonoscopies in ambulatory surgery centers.
  
  
  METHODS
  Colonoscopy.
  
  
  METHODS
  The number of colonoscopies with an adenomatous polyp divided by the total number of colonoscopies (ADR-T), inclusive of indication and patient's sex.
  
  
  RESULTS
  Data from 368,157 colonoscopies were included for analysis from 11 practices. Three practice sites (5, 8, and 10) were significantly above and 2 sites (3, 7) were significantly below mean ADR-T, with a 95% confidence interval (CI). High-performing sites had 9.0% higher ADR-T than sites belonging to the lowest quartile (P < .001). The mean ADR-T remained stable for 9 of 11 sites. Regression analysis showed that the 2 practice sites where ADR-T varied had significant improvements in ADR-T during the 6-year period. For each, mean ADR-T improved an average of 0.5% per quarter for site 2 (P = .001) and site 3 (P = .021), which were average and low performers, respectively.
  
  
  CONCLUSIONS
  Summary-level data, which does not allow cross-reference of variables at an individual level.
  
  
  CONCLUSIONS
  We found performance disparities among practice sites remaining relatively consistent over a 6-year period. The ability of certain sites to sustain their high-performance over 6 years suggests that further research is needed to identify key organizational processes and physician incentives that improve the quality of colonoscopy.
authors.affiliation: GI Associates and Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Lyndon V
authors.initials: LV
authors.lastname: Hernandez
authors.affiliation: Gastroenterology Associates of North Texas, Fort Worth, Texas.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Deas
authors.affiliation: GI Associates, LLC, Milwaukee, Wisconsin.
authors.forename: Marc F
authors.initials: MF
authors.lastname: Catalano
authors.affiliation: GI Associates, LLC, Milwaukee, Wisconsin.
authors.forename: Nalini M
authors.initials: NM
authors.lastname: Guda
authors.affiliation: Digestive Health Specialists, Tacoma, Washington.
authors.forename: Lin
authors.initials: L
authors.lastname: Huang
authors.affiliation: Minnesota Gastroenterology, Minneapolis, Minnesota.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ketover
authors.affiliation: Borland-Groover Clinic, Jacksonville, Florida.
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Etzkorn
authors.affiliation: Gastroenterology Associates of North Texas, Fort Worth, Texas.
authors.forename: Kumar G
authors.initials: KG
authors.lastname: Gutta
authors.affiliation: Atlanta Gastroenterology Associates, Atlanta, Georgia.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Morris
authors.affiliation: GI Associates, LLC, Milwaukee, Wisconsin.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schmalz
authors.affiliation: Central Washington University, Ellensburg, Washington.
authors.forename: Dominic
authors.initials: D
authors.lastname: Klyve
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: John I
authors.initials: JI
authors.lastname: Allen
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis*; D000368:Aged; D019985:Benchmarking; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000639:trends*