TY - JOUR
T1 - Associations between endoscopist feedback and improvements in colonoscopy quality indicators
T2 - a systematic review and meta-analysis
AU - Bishay, Kirles
AU - Causada-Calo, Natalia
AU - Scaffidi, Michael A.
AU - Walsh, Catharine M.
AU - Anderson, John T.
AU - Rostom, Alaa
AU - Dube, Catherine
AU - Keswani, Rajesh N.
AU - Heitman, Steven J.
AU - Hilsden, Robert J.
AU - Shorr, Risa
AU - Grover, Samir C.
AU - Forbes, Nauzer
N1 - Funding Information:
DISCLOSURE: Dr Keswani is a consultant for Boston, Scientific. Dr Hilsden has a research contract with Freenome Holdings Inc. and Exact Sciences Co. Dr Grover receives research funding from Abbvie, Janssen, Takeda and Olympus; receives consulting fees from Ferring; and owns shares of Volo Healthcare. All other authors disclosed no financial relationships.
Funding Information:
DISCLOSURE: Dr Keswani is a consultant for Boston, Scientific. Dr Hilsden has a research contract with Freenome Holdings Inc. and Exact Sciences Co. Dr Grover receives research funding from Abbvie, Janssen, Takeda and Olympus; receives consulting fees from Ferring; and owns shares of Volo Healthcare. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2020 American Society for Gastrointestinal Endoscopy
PY - 2020/11
Y1 - 2020/11
N2 - Background and Aims: Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. It is unclear whether endoscopist feedback on these indicators improves performance. We performed a meta-analysis to determine whether associations exist between endoscopist feedback and colonoscopy performance. Methods: We conducted a search through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Pooled rate ratios (RRs) and weighted mean differences were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity, and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes. Results: From 1326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR, 1.21; 95% confidence interval [CI], 1.09-1.34). Low performers derived a greater benefit from feedback (RR, 1.62; 95% CI, 1.18-2.23) compared with moderate performers (RR, 1.19; 95% CI, 1.11-1.29), whereas high performers did not derive a significant benefit (RR, 1.06; 95% CI, 0.99-1.13). Feedback was not associated with increases in withdrawal time (weighted mean difference, +0.43 minutes; 95% CI, −0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR, 1.00; 95% CI, 0.99-1.01). Conclusion: Endoscopist feedback is associated with modest improvements in ADR. The implementation of routine endoscopist audit and feedback should be considered alongside other quality improvement interventions in institutions dedicated to the provision of high-quality screening-related colonoscopy.
AB - Background and Aims: Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. It is unclear whether endoscopist feedback on these indicators improves performance. We performed a meta-analysis to determine whether associations exist between endoscopist feedback and colonoscopy performance. Methods: We conducted a search through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Pooled rate ratios (RRs) and weighted mean differences were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity, and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes. Results: From 1326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR, 1.21; 95% confidence interval [CI], 1.09-1.34). Low performers derived a greater benefit from feedback (RR, 1.62; 95% CI, 1.18-2.23) compared with moderate performers (RR, 1.19; 95% CI, 1.11-1.29), whereas high performers did not derive a significant benefit (RR, 1.06; 95% CI, 0.99-1.13). Feedback was not associated with increases in withdrawal time (weighted mean difference, +0.43 minutes; 95% CI, −0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR, 1.00; 95% CI, 0.99-1.01). Conclusion: Endoscopist feedback is associated with modest improvements in ADR. The implementation of routine endoscopist audit and feedback should be considered alongside other quality improvement interventions in institutions dedicated to the provision of high-quality screening-related colonoscopy.
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U2 - 10.1016/j.gie.2020.03.3865
DO - 10.1016/j.gie.2020.03.3865
M3 - Review article
C2 - 32330506
AN - SCOPUS:85087677097
SN - 0016-5107
VL - 92
SP - 1030-1040.e9
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 5
ER -