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Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: the NED APRIQOT Randomised Controlled Trial.

Catlow, Jamie; Sharp, Linda; Wagnild, Janelle; Lu, Liya; Bhardwaj-Gosling, Rashmi; Ogundimu, Emmanuel; Kasim, Adetayo; Brookes, Matthew; Lee, Thomas; McCarthy, Stephen; Gray, Joanne; Sniehotta, Falko; Valori, Roland; Westwood, Claire; McNally, Richard; Ruwende, Josephine; Sinclair, Simon; Deane, Jill; Rutter, Matt

Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: the NED APRIQOT Randomised Controlled Trial. Thumbnail


Authors

Jamie Catlow

Linda Sharp

Liya Lu

Rashmi Bhardwaj-Gosling

Adetayo Kasim

Matthew Brookes

Thomas Lee

Stephen McCarthy

Joanne Gray

Falko Sniehotta

Roland Valori

Claire Westwood

Richard McNally

Josephine Ruwende

Simon Sinclair

Jill Deane

Matt Rutter



Abstract

Post-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted Mean Number of Polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed evidence-based audit and feedback intervention. This multicentre, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) randomised NHS endoscopy centres to intervention or control. Intervention-arm endoscopists were emailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behaviour change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention. From November 2020-July 2021, 541 endoscopists across 36 centres (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-months post-intervention period. Comparing intervention-arm to control-arm endoscopists during the intervention period: aMNP was non-significantly higher (7%, 95% confidence interval (CI) -1% to 14%; p=0·08). Unadjusted MNP (10%, 95%CI 1-20%) and polyp detection rate (PDR) (10%, 95%CI 4-16%) were significantly higher. Differences were not maintained in the post-intervention period. In the intervention-arm, endoscopists accessing NED-APRIQOT webpages had higher aMNP than those who did not (118 vs 102 aMNP, p=0.03). Although our automated feedback intervention did not increase aMNP significantly in the intervention period; MNP and PDR did significantly improve. Engaged endoscopists benefited most and improvements were not maintained post-intervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback.

Citation

Catlow, J., Sharp, L., Wagnild, J., Lu, L., Bhardwaj-Gosling, R., Ogundimu, E., Kasim, A., Brookes, M., Lee, T., McCarthy, S., Gray, J., Sniehotta, F., Valori, R., Westwood, C., McNally, R., Ruwende, J., Sinclair, S., Deane, J., & Rutter, M. (2024). Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: the NED APRIQOT Randomised Controlled Trial. Clinical Gastroenterology and Hepatology, 22(9), 1926-1936. https://doi.org/10.1016/j.cgh.2024.03.048

Journal Article Type Article
Acceptance Date Mar 29, 2024
Online Publication Date May 15, 2024
Publication Date May 15, 2024
Deposit Date Jun 11, 2024
Publicly Available Date Jun 11, 2024
Journal Clinical Gastroenterology and Hepatology
Print ISSN 1542-3565
Electronic ISSN 1542-3565
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 22
Issue 9
Pages 1926-1936
DOI https://doi.org/10.1016/j.cgh.2024.03.048
Keywords Detection, Quality improvement, Audit and feedback, Endoscopy
Public URL https://durham-repository.worktribe.com/output/2471616

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