Many physicians bristle at numerous quality measures due to concerns that they may have little relevance to clinical practice or that they are not representative since they measure only a tiny fraction of their work. For adult gastroenterologists, adenoma detection rate may become a quality measure that will be more difficult to dismiss (NEJM 2014; 370: 1298-306).
Background: In this study, the authors evaluated 314,872 colonoscopies by 136 gastroenterologists by using data from an integrated health care delivery organization. They determined associations between adenoma detection rate and the risks of colorectal cancer/cancer-related deaths diagnosed 6 months to 10 years after colonoscopy. Estimates of attributable risk were adjusted for the demographics of the patients, indications for colonoscopy, and coexisting conditions.
- The adenoma detection rate varied considerably, from 7.4% to 52.5%.
- 712 colorectal adenocarcinomas were identified during followup, including 255 advanced-stage cancers.
- 147 deaths from interval colorectal cancer occurred.
- Among patients of physicians with adenoma detection rates in the highest quintile, compared with patients of physicians in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52; it was 0.43 for advanced-stage interval cancer and 0.38 for fatal interval cancer.
- For each 1% increase in the adenoma detection rate, there was an associated decrease in the risk of cancer by 3%.
Bottomline: Previous studies have shown that spending longer than 6 minutes on a screening colonoscopy increases detection rates. This study shows that doing a high quality colonoscopy really does alter the outcome.
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