Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial

Jamie Catlow; Linda Sharp; Janelle Wagnild; Liya Lu; Rashmi Bhardwaj-Gosling; Emmanuel Ogundimu; 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

doi:10.1016/j.cgh.2024.03.048

Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial

Jamie Catlow^*, Linda Sharp, Janelle Wagnild, Liya Lu, Rashmi Bhardwaj-Gosling, Emmanuel Ogundimu, 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

^*Corresponding author for this work

Nursing Midwifery and Health Department

Research output: Contribution to journal › Article › peer-review

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Abstract

Background and Aims
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.

Methods
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.

Results
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).

Conclusion
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.

www.isrctn.org ISRCTN11126923

Original language	English
Pages (from-to)	1926-1936
Number of pages	11
Journal	Clinical Gastroenterology and Hepatology
Volume	22
Issue number	9
Early online date	15 May 2024
DOIs	https://doi.org/10.1016/j.cgh.2024.03.048
Publication status	Published - 1 Sept 2024

Keywords

Audit and Feedback
Detection
Endoscopy
Quality Improvement

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.cgh.2024.03.048Licence: CC BY-NC-ND

PIIS154235652400449XAccepted author manuscript, 1.95 MBLicence: CC BY-NC-ND
PIIS154235652400449XFinal published version, 842 KBLicence: CC BY-NC-ND

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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 Randomized Controlled Trial. Clinical Gastroenterology and Hepatology, 22(9), 1926-1936. https://doi.org/10.1016/j.cgh.2024.03.048

@article{c1d3db2bdde6487bb278f8c8c26a6f68,

title = "Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial",

abstract = "Background and AimsPost-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK{\textquoteright}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{\textquoteright} performance. Feedback was delivered via a theory-informed evidence-based audit and feedback intervention.MethodsThis 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{\textquoteright} aMNP during the 9-month intervention.ResultsFrom 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).ConclusionAlthough 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.www.isrctn.org ISRCTN11126923",

keywords = "Audit and Feedback, Detection, Endoscopy, Quality Improvement",

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

year = "2024",

month = sep,

day = "1",

doi = "10.1016/j.cgh.2024.03.048",

language = "English",

volume = "22",

pages = "1926--1936",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "9",

}

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 Randomized Controlled Trial', Clinical Gastroenterology and Hepatology, vol. 22, no. 9, pp. 1926-1936. https://doi.org/10.1016/j.cgh.2024.03.048

TY - JOUR

T1 - Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection

T2 - The NED APRIQOT Randomized Controlled Trial

AU - Catlow, Jamie

AU - Sharp, Linda

AU - Wagnild, Janelle

AU - Lu, Liya

AU - Bhardwaj-Gosling, Rashmi

AU - Ogundimu, Emmanuel

AU - Kasim, Adetayo

AU - Brookes, Matthew

AU - Lee, Thomas

AU - McCarthy, Stephen

AU - Gray, Joanne

AU - Sniehotta, Falko

AU - Valori, Roland

AU - Westwood, Claire

AU - McNally, Richard

AU - Ruwende, Josephine

AU - Sinclair, Simon

AU - Deane, Jill

AU - Rutter, Matt

PY - 2024/9/1

Y1 - 2024/9/1

N2 - Background and AimsPost-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.MethodsThis 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.ResultsFrom 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).ConclusionAlthough 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.www.isrctn.org ISRCTN11126923

AB - Background and AimsPost-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.MethodsThis 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.ResultsFrom 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).ConclusionAlthough 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.www.isrctn.org ISRCTN11126923

KW - Audit and Feedback

KW - Detection

KW - Endoscopy

KW - Quality Improvement

UR - http://www.scopus.com/inward/record.url?scp=85197091582&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2024.03.048

DO - 10.1016/j.cgh.2024.03.048

M3 - Article

SN - 1542-3565

VL - 22

SP - 1926

EP - 1936

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 9

ER -

Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial

Abstract

Keywords

UN SDGs

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