The Effect of a Colonoscopy Skills Report Card on Colonoscopy Technique

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Importantly, colonoscopy can reduce the risk of death from CRC through the detection and removal of pre-cancerous polyps (known as adenomas). Unfortunately, the quality of colonoscopy varies widely between doctors. Most commonly, the quality of colonoscopy is measured by the adenoma detection rate (ADR); the ADR is the frequency at which a doctor finds adenomas in patients undergoing routine screening colonoscopy. Patients who undergo a colonoscopy by a doctor with a high ADR are less likely to develop CRC than patients who undergo a colonoscopy by a doctor with a low ADR. Although ADR varies widely among individual doctors, the source of this variability is incompletely understood and is a target of intense interest. We hypothesize that structured and specific feedback regarding performance in colonoscopy inspection quality and polypectomy technique through the administration of individualized “report cards” will improve subsequent provider performance. Phase 1: We will create and deliver CIQ and polypectomy “report cards” to each colonoscopist. These reports cards will contain each doctor’s baseline (Phase 0) scores, including: 1) overall CIQ score and the 3 CIQ component scores (fold examination, cleaning, and colon distention); and 2) polypectomy skill scores. Providers will receive this data with benchmarking relative to peers (i.e., how they performed compared to peers). We will also include videobased didactics, prepared by the study team, demonstrating optimal technique (i.e., what technique constitutes an optimal score). Phase 2: We will record >28 additional colonoscopies per endoscopist within 3 months of report card delivery. We will then randomly select 7 previously un-utilized colonoscopy videos from Phase 0 (pre-report card videos) and 7 colonoscopy videos from Phase 2 (post-report card videos). Blinded experts will review these videos and grade CIQ and polypectomy technique.