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

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., …Rutter, M. (2024). Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: the NED APRIQOT Randomised Controlled Trial. Clinical Gastroenterology and Hepatology, 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
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• 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