Time trends in quality indicators of colonoscopy

Abstract

Background: There is considerable variation in the quality of colonoscopy performance. The Norwegian quality assurance programme Gastronet registers outpatient colonoscopies performed in Norwegian endoscopy centres. The aim of Gastronet is long-term improvement of endoscopist and centre performance by annual feedback of performance data.

Objective: The objective of this article is to perform an analysis of trends of quality indicators for colonoscopy in Gastronet.

Methods: This prospective cohort study included 73,522 outpatient colonoscopies from 73 endoscopists at 25 endoscopy centres from 2003 to 2012. We used multivariate logistic regression with adjustment for relevant variables to determine annual trends of three performance indicators: caecum intubation rate, pain during the procedure, and detection rate of polyps ≥5 mm.

Results: The proportion of severely painful colonoscopies decreased from 14.8% to 9.2% (relative risk reduction of 38%; OR = 0.92 per year in Gastronet; 95% CI 0.86-1.00; p = 0.045). Caecal intubation (OR = 0.99; 95% CI 0.94-1.04; p = 0.6) and polyp detection (OR = 1.03; 95% CI 0.99-1.07; p = 0.15) remained unchanged during the study period.

Conclusions: Pain at colonoscopy showed a significant decrease during years of Gastronet participation while caecal intubation and polyp detection remained unchanged - independent of the use of sedation and/or analgesics and level of endoscopist experience. This may be due to the Gastronet audit, but effects of improved endoscopy technology cannot be excluded.

Keywords: Abdominal pain; caecum intubation rate; colonoscopy; polyp detection rate; quality assurance; quality indicator.

Figure 1.

Flowchart showing the inclusion and exclusion criteria for colonoscopies and endoscopists in the total study period 2003–2012 for analysis of the three quality indicators (caecal intubation, severe pain and detection of polyps >5 mm (polyp detection rate (PDR)-5 mm). PDR-5 mm was registered in 2006–2012 only.

Figure 2.

The course of participation for the 25 endoscopy centres in the study period 2003–2012.

Figure 3.

Development of quality indicators (polyp detection rate (PDR) ≥ 5 mm, severe pain, completed colonoscopy) in Gastronet as mean percentage of all participating endoscopists’ colonoscopies per year.

Figure 4.

Three scatterplot diagrams (Figure 4(a)–(c)) depicting the variation of the participating endoscopists’ performance with regard to the three quality indicators (caecal intubation rate (CIR) (a), percentage of colonoscopies with severe pain (b) and polyp detection rate (PDR) (c)) per Gastronet year of participation. One circle represents one endoscopist’s performance result for this particular Gastronet year. The red line indicates the desired level of performance (CIR ≥ 90%, none for severe pain and PDR-5 mm ≥ 25%).