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    Benchmarks for Quality of Colonoscopy Screening

    There has been increased emphasis in recent years on the quality of screening procedures, in addition to their appropriate use. To measure colonoscopy quality, gastroenterologists frequently use three benchmarks. All of the benchmarked data can be collected during a colonoscopy and measured. When compared with the national benchmark, these measurements give us a picture of the performance of our physicians. We describe these three benchmarks below.

    1. Cecal intubation rate

    This is the rate at which an endoscopist reaches the cecum (the first part of the large intestine) with the colonoscope. Seeing the entire colon is vital to a high-quality examination, and on average, it is expected that gastroenterologists will reach the cecum in 95% of cases. The most important factor in performance quality is seeing the entire colon. By reaching the cecum and identifying the landmarks of the ileocecal valve and the appendiceal orifice, the gastroenterologist is ensuring that all of the colon can be carefully examined during colonoscope withdrawal. Our doctors reached the cecum in almost 98% of all colonoscopies (Figure 5), compared with 95% for the national benchmark (1).

    FIGURE 5
    PERCENT OF PAMF COLONOSCOPIES WHERE CECUM WAS REACHED
    (1,958 PATIENTS, 2011-2012)
    VS. THE NATIONAL BENCHMARK

    Figure represents percent of PAMF colonoscopies where cecum, the first part of the large intestine, was reached vs. the national benchmark, with 97.85% of patients vs. the national benchmark of 95%. Seeing the entire colon is vital to a high-quality exam, & on average, it is expected that gastroenterologist will reach the cecum in 95% of cases
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    2. Colonoscopy withdrawal time

    This is the amount of time a physician spends removing the colonoscope and examining the colon. Gastroenterologists should spend at least 6 minutes removing the endoscope and examining the colon after they reach the cecum, according to the American Society for Gastrointestinal Endoscopy/American Gastroenterology Association (ASGE/AGA) Taskforce on Quality in Endoscopy. Studies have confirmed that slower withdrawal times increase polyp detection rates (2), and withdrawal times aim to maximize polyp detection rates. Withdrawal times averaged 14 minutes per colonoscopy for the years 2011-2012 versus the national benchmark of 6 minutes (Figure 6) (1). It has been shown that higher polyp detection rates result in increased overall colorectal cancer detection (3) and decreased incidence of colon cancer (1).

    FIGURE 6
    AVERAGE COLONOSCOPY WITHDRAWAL TIME
    (1,920 PATIENTS, 2011-2012)
    VS. THE NATIONAL BENCHMARK

    Figure represents the average colonoscopy withdrawal time, the time a physician spends removing the colonoscope & examining the colon. The withdrawal time for PAMF was 14 minutes vs. the national benchmark of 6 minutes between 2011 & 2012.Studies have confirmed that slower withdrawal times increase polyp detection rates
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    3. Adenoma detection rate

    The most important quality indicator, this is the number of screened patients in whom a precancerous polyp is identified and removed. Removal of colon polyps leads to a decrease in the incidence and prevalence of colon cancer. In a high-quality screening program, adenomas should be identified (and removed) in 15% of women and 25% of men undergoing screening colonoscopies.

    From July through December 2011, at least one adenoma was detected in 42% of screened female patients at PAMF, compared with 15% for the U.S. national benchmark (Figure 7) (1). Our higher detection rate translates into lower morbidity and mortality rates. The results for male patients were similar: 50% of screened males at PAMF had one or more adenomas, compared with 25% for the U.S. benchmark.

    FIGURE 7
    PERCENT OF PATIENTS, BY SEX, WITH SCREENING COLONOSCOPIES
    WHEN ONE OR MORE ADENOMAS WERE DETECTED
    VS. THE NATIONAL BENCHMARK
    (8,016 PATIENTS, JULY-DECEMBER 2011)*

    Figure represents the percent of patients, by sex, with screening colonoscopies when one or more adenomas were detected, with a comparison of PAMF patients being females at 42% vs. 15% national benchmark, & 50% of males vs. 25% national benchmark.

    * Screening colonoscopies are low-risk procedures. These colonoscopies have diagnostic codes of V76.51 ± 211.3, ± 211.4.
    **PAMF adenoma detection rate calculation includes sessile serrated adenomas.

    The overall detection rate of adenomas for screening colonoscopies at PAMF during the same period was 46% (Figure 8).

    FIGURE 8
    TOTAL ADENOMAS DOCUMENTED FROM SCREENING COLONOSCOPIES AT PAMF
    (3,768 PATIENTS, JULY-DECEMBER 2011)

    Figure represents the total adenomas documented from screening colonoscopies, in which 8,016 patients were screened & 3,695 patients screenings detected an adenoma or 46% of screened patients.

    TABLE 1
    TOTAL ADENOMAS DOCUMENTED FROM PAMF SCREENING COLONOSCOPIES
    (3,768 PATIENTS, JULY-DECEMBER 2011)
    ADENOMA DETECTION RATE = 46%

    Table represents total adenomas documented from screening colonoscopies between July & December 2011. Of those screened 84.1% had tubular adenomas, 3.2% had tubulovillous, 0.4% had villous adenomas, & 12.3% had sessile serrated adenomas.
    * 5,278 Smart Phrases entered; data obtained from Epic Smart Phrases.

    For all three of these benchmarks, our physicians performed well above the national benchmark. These quality data are monitored on a regular basis. The PAMF Digestive Health Specialty Program quality data provide strong evidence that our physicians have given their patients outstanding care.
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