title: Comparison of Colonoscopy Quality Measures Across Various Practice Settings and the Impact of Performance Scorecards.
abstract: Quality performance measures for screening colonoscopy vary among endoscopists. The impact of practice setting is unknown.
  
  
  
  We aimed to (1) compare screening colonoscopy performance measures among three different US practice settings; (2) evaluate factors associated with adenoma detection; and (3) assess a scorecard intervention on performance metrics.
  
  
  
  This multi-center prospective study compared patient, endoscopist, and colonoscopy characteristics performed at a tertiary care hospital (TCH), community-based hospital (CBH), and private practice group (PPG). Withdrawal times (WT), cecal intubation, and adenoma detection rates (ADR) were compared by site at baseline and 12 weeks following scorecard distribution. Generalized linear mixed models identified factors associated with adenoma detection.
  
  
  
  Twenty-eight endoscopists performed colonoscopies on 1987 asymptomatic, average-risk individuals ≥50 years. Endoscopist and patient characteristics were similar across sites. The PPG screened more men (TCH: 42.8%, CBH: 45.0%, PPG: 54.2%; p < 0.0001). Preparation quality varied with good/excellent results in 70.6, 88.3, and 92% of TCH, CBH, and PPG cases, respectively (p < 0.0001). Male ADRs, cecal intubation, and WT exceeded recommended benchmarks despite variable results at each site; female ADRs were <15% at the PPG which screened the fewest females. Performance remained unchanged following scorecard distribution. Adenoma detection was associated with increasing patient age, male gender, WT, adequate preparation, but not practice setting.
  
  
  
  Each practice performed high-quality screening colonoscopy. Scorecards did not improve performance metrics. Preparation quality varies among practice settings and can be modified to improve adenoma detection.
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Inra
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. jnayor@partners.org.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. jnayor@partners.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nayor
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA, 02115, USA.
authors.forename: Margery
authors.initials: M
authors.lastname: Rosenblatt
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors.forename: Muthoka
authors.initials: M
authors.lastname: Mutinga
authors.affiliation: Division of Gastroenterology, South Shore Hospital, 1681 Washington Street, Braintree, South Weymouth, MA, 02184, USA.
authors.forename: Sarathchandra I
authors.initials: SI
authors.lastname: Reddy
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.|Division of Population Sciences, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA, 02115, USA.
authors.forename: Sapna
authors.initials: S
authors.lastname: Syngal
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
authors.forename: Fay
authors.initials: F
authors.lastname: Kastrinos
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis / Q000453:epidemiology; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D005260:Female; D000072102:Gastroenterologists / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006764:Hospitals, Community / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011331:Private Practice / Q000592:standards*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D062606:Tertiary Care Centers / Q000592:standards
keywords: Adenoma detection; Performance scorecard; Quality improvement; Screening colonoscopy