Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: the NED APRIQOT Randomised Controlled Trial.

Audit and feedback Detection Endoscopy Quality improvement

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
15 May 2024
Historique:
received: 22 11 2023
revised: 27 03 2024
accepted: 29 03 2024
medline: 18 5 2024
pubmed: 18 5 2024
entrez: 17 5 2024
Statut: aheadofprint

Résumé

Post-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted Mean Number of Polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed evidence-based audit and feedback intervention. This multicentre, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) randomised NHS endoscopy centres to intervention or control. Intervention-arm endoscopists were emailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behaviour change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention. From November 2020-July 2021, 541 endoscopists across 36 centres (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-months post-intervention period. Comparing intervention-arm to control-arm endoscopists during the intervention period: aMNP was non-significantly higher (7%, 95% confidence interval (CI) -1% to 14%; p=0·08). Unadjusted MNP (10%, 95%CI 1-20%) and polyp detection rate (PDR) (10%, 95%CI 4-16%) were significantly higher. Differences were not maintained in the post-intervention period. In the intervention-arm, endoscopists accessing NED-APRIQOT webpages had higher aMNP than those who did not (118 vs 102 aMNP, p=0.03). Although our automated feedback intervention did not increase aMNP significantly in the intervention period; MNP and PDR did significantly improve. Engaged endoscopists benefited most and improvements were not maintained post-intervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback. www.isrctn.org ISRCTN11126923.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Post-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted Mean Number of Polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed evidence-based audit and feedback intervention.
METHODS METHODS
This multicentre, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) randomised NHS endoscopy centres to intervention or control. Intervention-arm endoscopists were emailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behaviour change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention.
RESULTS RESULTS
From November 2020-July 2021, 541 endoscopists across 36 centres (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-months post-intervention period. Comparing intervention-arm to control-arm endoscopists during the intervention period: aMNP was non-significantly higher (7%, 95% confidence interval (CI) -1% to 14%; p=0·08). Unadjusted MNP (10%, 95%CI 1-20%) and polyp detection rate (PDR) (10%, 95%CI 4-16%) were significantly higher. Differences were not maintained in the post-intervention period. In the intervention-arm, endoscopists accessing NED-APRIQOT webpages had higher aMNP than those who did not (118 vs 102 aMNP, p=0.03).
CONCLUSION CONCLUSIONS
Although our automated feedback intervention did not increase aMNP significantly in the intervention period; MNP and PDR did significantly improve. Engaged endoscopists benefited most and improvements were not maintained post-intervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback. www.isrctn.org ISRCTN11126923.

Identifiants

DOI: 10.1016/j.cgh.2024.03.048 PMID: 38759827
pubmed: 38759827
pii: S1542-3565(24)00449-X
doi: 10.1016/j.cgh.2024.03.048
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Jamie Catlow (J)

. Newcastle University, Population Health and Society, Newcastle upon Tyne, UK NE1 7RU; . Newcastle Upon Tyne Hospitals NHS Foundation Trust, Gastroenterology, Newcastle Upon Tyne, UK NE1 4LP. Electronic address: Jamie.catlow@nhs.net.

Linda Sharp (L)

Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, Tyne and Wear, UK NE1 7RU.

Janelle Wagnild (J)

Durham University Department of Anthropology, Durham, Durham, UK DH1 3LE.

Liya Lu (L)

Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, Newcastle upon Tyne, UK NE1 7RU.

Rashmi Bhardwaj-Gosling (R)

University of Sunderland, Faculty of Health Sciences & Wellbeing, Sunderland, UK SR1 3SD; Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, Tyne and Wear, UK NE1 7RU.

Emmanuel Ogundimu (E)

Durham University Department of Mathematical Sciences, Stockton Road, Durham, North-East, UK DH1 3LE.

Adetayo Kasim (A)

Durham University, Durham, Durham, UK DH1 3LE.

Matthew Brookes (M)

Royal Wolverhampton Hospitals NHS Trust, Department of Gastroenterology, Wolverhampton, UK WV10 0QP; University of Wolverhampton, Wolverhampton, UK WV1 1LY.

Thomas Lee (T)

Northumbria Healthcare NHS Foundation Trust, Gastroenterology, North Shields, UK NE29 8NH.

Stephen McCarthy (S)

Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK NE1 8ST.

Joanne Gray (J)

Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK NE1 8ST.

Falko Sniehotta (F)

Professor of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, 68167 Mannheim.

Roland Valori (R)

Gloucestershire Hospitals NHS Foundation Trust, Great Western Road, Gloucester, GL1 3NN.

Claire Westwood (C)

University Hospital of North Tees, Stockton-on-Tees, UK TS19 8PE.

Richard McNally (R)

Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK NE1 7RU.

Josephine Ruwende (J)

NHS London, London, London, UK SE1 6LH.

Simon Sinclair (S)

North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, UK TS19 8PE.

Jill Deane (J)

North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, UK TS19 8PE.

Matt Rutter (M)

North Tees and Hartlepool NHS Foundation Trust, Gastroenterology, Hardwick Rd, Stockton on Tees, UK TS19 8PE; Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK NE1 7RU.

Classifications MeSH