Prospective Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2014; 20(43): 16300-16305
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16300
Screening polypectomy rates below quality benchmarks: A prospective study
Maida J Sewitch, Mengzhu Jiang, Mélanie Fon Sing, Alan Barkun, Lawrence Joseph
Maida J Sewitch, Alan Barkun, Department of Medicine, McGill University, Montréal, Québec H3G 1Y6, Canada
Mengzhu Jiang, Mélanie Fon Sing, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montréal, Québec H3A 1A1, Canada
Lawrence Joseph, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec H3A 1A2, Canada
Author contributions: Sewitch MJ conceived of the study and its design, and prepared the manuscript; Jiang M and Fon Sing M helped conduct the data analysis and prepare the manuscript; Barkun A critically reviewed the article for important intellectual content; Joseph L participated in the study design and supervised the data analysis; all authors have contributed to, seen and approved the manuscript.
Supported by Canadian Cancer Society, No. 017054; and Fonds de Recherche Santé Québec, No. 14003
Correspondence to: Maida J Sewitch, PhD, Associate Professor, Department of Medicine, McGill University, 687 Pine Avenue West, V Building Room V2.15, Montréal Québec H3A 1A1, Canada. maida.sewitch@mcgill.ca
Telephone: +1-514-9341934 Fax: +1-514-9348293
Received: January 9, 2014
Revised: May 5, 2014
Accepted: June 13, 2014
Published online: November 21, 2014
Abstract

AIM: To estimate and compare sex-specific screening polypectomy rates to quality benchmarks of 40% in men and 30% in women.

METHODS: A prospective cohort study was undertaken of patients aged 50-75, scheduled for colonoscopy, and covered by the Québec universal health insurance plan. Endoscopist and patient questionnaires were used to obtain screening and non-screening colonoscopy indications. Patient self-report was used to obtain history of gastrointestinal conditions/symptoms and prior colonoscopy. Sex-specific polypectomy rates (PRs) and 95%CI were calculated using Bayesian hierarchical logistic regression.

RESULTS: In total, 45 endoscopists and 2134 (mean age = 61, 50% female) of their patients participated. According to patients, screening PRs in males and females were 32.4% (95%CI: 23.8-41.8) and 19.4% (95%CI: 13.1-25.4), respectively. According to endoscopists, screening PRs in males and females were 30.2% (95%CI: 27.0-41.9) and 16.6% (95%CI: 16.3-28.6), respectively. Sex-specific PRs did not meet quality benchmarks at all ages except for: males aged 65-69 (patient screening indication), and males aged 70-74 (endoscopist screening indication). For all patients aged 50-54, none of the CI included the quality benchmarks.

CONCLUSION: Most sex-specific screening PRs in Québec were below quality benchmarks; PRs were especially low for all 50-54 year olds.

Keywords: Benchmarking, Colonoscopy, Colorectal cancer, Quality assurance, Screening

Core tip: Colonoscopy quality is essential to effective colorectal cancer screening. Polypectomy rates (PRs) of 40% in men and 30% in women have recently been proposed as screening colonoscopy quality indicators. In this prospective cohort study, we sought to estimate and compare screening PRs in Québec with published screening colonoscopy quality benchmarks. We found that sex-specific screening PRs benchmarks were rarely met. The very low screening PRs in patients aged 50-54 could not be explained by shorter than recommended screening intervals. Further research is needed to understand the discrepancy between quality benchmarks and clinical practice.