title: Comparison of cecal intubation and adenoma detection between hospitals can provide incentives to improve quality of colonoscopy.
abstract: OBJECTIVE
  Cecal intubation rate (CIR) and adenoma detection rate (ADR) have been found to be inversely associated with the occurrence of post-colonoscopy colorectal cancer. Depicting differences in CIR and ADR between hospitals could provide incentives for quality improvement. The aim of this study was to compare quality parameters of routine colonoscopies between seven hospitals in The Netherlands in order to determine the extent to which possible differences were attributable to procedural and institutional factors.
  
  
  METHODS
  Consecutive patients undergoing colonoscopy were prospectively included between November 2012 and January 2013 at two academic and five nonacademic hospitals. Patients with inflammatory bowel disease or hereditary colorectal cancer syndromes were excluded. Main outcome measures were CIR and ADR.
  
  
  RESULTS
  A total of 3129 patients were included (mean age 59 ± 15 years; 45.5 % male). The majority of patients (86.2 %) had a Boston Bowel Preparation Scale (BBPS) score ≥ 6. Overall CIR was 94.8 %, ranging from 89.4 % to 99.2 % between hospitals. After adjustment for case mix (age, sex, American Society of Anesthesiologists score, and indication for colonoscopy), factors associated with CIR were hospital and a BBPS score ≥ 6. Overall ADR was 31.8 % and varied between hospitals, ranging from 24.8 % to 46.8 %. Independent predictors for ADR were hospital, BBPS score ≥ 6, and cecal intubation. By combining CIR and ADR for each hospital, a colonoscopy quality indicator (CQI) was developed, which can be used by hospitals to stimulate quality improvement.
  
  
  CONCLUSIONS
  Differences in the quality of colonoscopy between hospitals can be demonstrated using CIR and ADR. As both indicators are affected by institution and bowel preparation, a comparison between hospitals based on the newly developed CQI could assist in further improving the quality of colonoscopy.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Tim D G
authors.initials: TD
authors.lastname: Belderbos
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Grobbee
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Maarten A C
authors.initials: MA
authors.lastname: Meijssen
authors.affiliation: Department of Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Rob J T
authors.initials: RJ
authors.lastname: Ouwendijk
authors.affiliation: Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle a/d IJssel, The Netherlands.
authors.forename: Thjon J
authors.initials: TJ
authors.lastname: Tang
authors.affiliation: Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: ter Borg
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Schaar
authors.affiliation: Achmea Health Care, Leiden, The Netherlands.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Le Fèvre
authors.affiliation: Gupta Strategists, Ophemert, The Netherlands.
authors.forename: Merijn T
authors.initials: MT
authors.lastname: Stouten
authors.affiliation: Achmea Health Care, Leiden, The Netherlands.
authors.forename: Onno
authors.initials: O
authors.lastname: van der Galiën
authors.affiliation: Achmea Health Care, Leiden, The Netherlands.
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Hiemstra
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Wouter H
authors.initials: WH
authors.lastname: de Vos tot Nederveen Cappel
authors.affiliation: Department of Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Pieter C J
authors.initials: PC
authors.lastname: ter Borg
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Manon C W
authors.initials: MC
authors.lastname: Spaander
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Leon M G
authors.initials: LM
authors.lastname: Moons
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007440:Intubation / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D058996:Quality Improvement; D015203:Reproducibility of Results