SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2015/10  
 
  2015 Oct;82(4):676-82  
  doi: 10.1016/j.gie.2014.12.058  
 
  Public reporting of colonoscopy quality is associated with an increase in endoscopist adenoma detection rate  
 
  Abdul-Baki H, Schoen RE, Dean K, Rose S, Leffler DA, Kuganeswaran E, Morris M, Carrell D, Mehrotra A  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Public+reporting+of+colonoscopy+quality+is+associated+with+an+increase+in+endoscopist+adenoma+detection+rate  
 
 

BACKGROUND: Colonoscopy is the predominant method for colorectal cancer screening in the United States. Previous studies have documented variation across physicians in colonoscopy quality as measured by the adenoma detection rate (ADR). ADR is the primary quality measure of colonoscopy examinations and an indicator of the likelihood of subsequent colorectal cancer. There is interest in mechanisms to improve the ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality.

OBJECTIVE: We assessed whether this initiative was associated with an improvement in the ADR.

DESIGN: We compared ADRs before and after public reporting at a private practice endoscopy center with 11 gastroenterologists in Peoria, Illinois, who participated in the initiative. To generate the ADR, colonoscopy and pathology reports from examinations performed over 4 years at the endoscopy center were analyzed by using previously validated natural language processing software.

SETTING: A central Illinois endoscopy center.

RESULTS: The ADR in the pre-public reporting period was 34.3% and 39.2% in the post-public reporting period (an increase of 4.9%, P < .001). The increase in the right-sided ADR was 5.1% (P < .01), whereas the increase in the left-sided ADR was 2.1% (P < .05). The increase in the ADR was 7.8% for screening colonoscopies (P < 0.05) and 3.5% for nonscreening colonoscopies (P < .05). All but 1 physician's ADR increased (range -2.7% to 10.5%). There was no statistically significant change in the advanced ADR (increase of 0.8%, P = .22).

LIMITATIONS: There was no concurrent control group to assess whether the increased ADR was due to a secular trend.

CONCLUSION: A public reporting initiative on colonoscopy quality was associated with an increase in ADR.

 
Question posée
 
Le fait de déclarer publiquement son taux de détection d’adénomes (TDA) coliques permet-il de s’améliorer ?
 
Question posée
 
Les auteurs de ce travail montrent que leur TDA a significativement progressé de 34,3% à 39,2% (surtout en ce qui concerne les adénomes du colon droit) entre une période ‘avant’ et une période ‘après’ déclaration publique’ de leurs performances en coloscopie.
 
Commentaires

Ce travail très original est sujet à de nombreux biais dont l’absence de bras contrôle, mais n’en demeure pas moins intéressant si l’on considère que la motivation de l’endoscopiste est probablement le premier et le meilleur outil de détection des adénomes !

 
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