title: Temporal trends and variability of colonoscopy performance in a gastroenterology practice.
abstract: OBJECTIVE
  Quality measures for colonoscopy are operator dependent and vary. It is unclear whether quality measures change over time. In this study, time-dependent variation in colonoscopy performance was examined in a gastroenterology practice.
  
  
  METHODS
  Colonoscopy and histopathology records that were collected at three hospitals (one university and two non-university hospitals) over three time periods (2007, 2010, and 2013) were reviewed. Data from colonoscopists performing at least 100 procedures per year were analyzed. Inter-colonoscopist variation in performance (i. e. adjusted cecal intubation rate [aCIR], adenoma detection rate [ADR], advanced ADR, mean adenomas per procedure [MAP], proximal ADR, nonpolypoid ADR, and serrated polyp detection rate) were examined using coefficients of variation. Logistic regression analyses were also performed, adjusting for covariates.
  
  
  RESULTS
  A total of 23 colonoscopists performing 6400 procedures were included. Overall, the mean aCIR, ADR, MAP, and proximal ADR improved significantly over time, from 91.9 %, 22.5 %, 0.37, and 10.2 % in 2007 to 95.3 %, 25.8 %, 0.45, and 13.4 %, respectively, in 2013 (P < 0.05). The inter-colonoscopist variation in ADR decreased from 37 % in 2007 to 15 % in 2013 (P < 0.05). In the non-university hospitals, mean values for quality measures increased significantly over time, whereas they remained stable in the university hospital.
  
  
  CONCLUSIONS
  Variability in performance among colonoscopists decreased significantly within the gastroenterology clinical practice. Core quality measures improved over time, mainly through improvement of the lower performers. Measurement of inter-colonoscopist variation in performance helps to identify factors that stimulate or hinder performance, and forms the basis for interventions.
  
  
  BACKGROUND
  http://www.trialregister.nl.
authors.affiliation: Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Chantal M C
authors.initials: CM
authors.lastname: le Clercq
authors.affiliation: Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Rick J
authors.initials: RJ
authors.lastname: Mooi
authors.affiliation: Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Bouke N H
authors.initials: BN
authors.lastname: Salden
authors.affiliation: Department of Internal Medicine and Gastroenterology, Atrium-Orbis Medical Center, Heerlen, The Netherlands.
authors.forename: C Minke
authors.initials: CM
authors.lastname: Bakker
authors.affiliation: Department of Internal Medicine and Gastroenterology, Atrium-Orbis Medical Center, Heerlen, The Netherlands.
authors.forename: Annick B
authors.initials: AB
authors.lastname: van Nunen
authors.affiliation: Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard, The Netherlands.
authors.forename: Eric P T
authors.initials: EP
authors.lastname: Keulen
authors.affiliation: Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Rogier J
authors.initials: RJ
authors.lastname: de Ridder
authors.affiliation: Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
authors.affiliation: Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanduleanu
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data / Q000639:trends*; D013997:Time Factors