FROM CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Two-thirds of endoscopists met national quality benchmarks for detecting colonic adenomas, but detection rates varied eightfold among male patients and 27-fold among female patients, according to a retrospective community-based cohort study.
These ranges narrowed somewhat when researchers controlled for patient-specific factors, such as age and sex, said Dr. Christopher Jensen and his associates at Kaiser Permanente Division of Research in Oakland, Calif. But researchers found that adjusting for those variables had little effect on how endoscopists ranked in terms of adenoma detection rates (ADRs) compared with their peers. Based on those findings, evaluators probably only need to account for patient demographics when comparing ADRs for endoscopists who tend to see very distinct types of patients, the investigators wrote in the April issue of Clinical Gastroenterology and Hepatology 2014 Oct 25. ( doi:10.1016/j.cgh.2014.10.020 ).
Colorectal cancer remains the second leading cause of cancer mortality in the United States, and prevention hinges on detecting and removing precancerous adenomatous polyps of the colon. For this reason, organizations such as the U.S. Multi-Society Task Force on Colorectal Cancer and the U.S. Centers for Medicaid and Medicare Services have recommended benchmark ADRs of at least 25% for male patients and 15% for female patients. Although some studies have examined how characteristics of physicians and their practices affect ADRs, none have previously assessed effects of patient-specific variables, Dr. Jensen and his associates said (Clin. Gastroenterol. Hepatol. http://www.ncbi.nlm.nih.gov/pubmed/25445767 .
The investigators retrospectively studied 108,662 colonoscopies and 20,792 screening colonoscopies carried out by 102 endoscopists at Kaiser Permanente Northern California between 2006 and 2008. They calculated ADRs for each physician before and after they adjusted for the patients’ age, sex, race/ethnicity, and family history of colorectal cancer.
In all, 67% of examiners met the gastrointestinal society guidelines for ADRs in male patients, and 68% met guidelines for female patients, the researchers found. But ADRs among the examiners ranged widely – from 7.7% to 61.5% for male patients and from 1.7% to 45.6% for females, the investigators said. Adjustments for patient demographics and family history of colorectal cancer cut the variation from 8-fold down to 3-fold for male patients, and from 27-fold to 5-fold for females. However, physicians’ absolute rankings among their peers remained similar before and after controlling for patient case mix. “Moderate differences in patient demographics between physicians are unlikely to substantially change rates of adenoma detection,” concluded Dr. Jensen and his associates. “The findings raise the question of whether adenoma detection rates should routinely be adjusted for case mix,” they added. “The need for adjustment will likely depend on the degree of variation between physicians in patient case mix, and how rates are used as a performance metric. Adjusted rates would likely only be needed in settings where physicians had very different patient demographics relative to sex and age.”
The study was funded by the Kaiser Permanente Community Benefits program, the National Cancer Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases. The investigators reported having no relevant financial disclosures.