Bi-annual Adenoma Detection Feedback Can Increase and Maintain a High Adenoma Detection Rate: A Community Group Study
Bibliographic record
Abstract
Purpose: This study was designed to monitor the quality of colonoscopies at our institution. Every 6 months, we provided a colonoscopy quality report to each physician. Over the past 2.5 years, our group of four gastroenterologists has made gradual improvements in our adenoma detection rate (ADR) and increases in withdraw time. We postulated that periodic feedback of individual ADR can improve and maintain high quality colonoscopies at our institution. Methods: The platform of our endoscopy system is Olympus 180 series, high definition. Beginning in July 2010, our group has systematically been recording the scope insertion time, withdraw time, number of polyps, and pathology of polyps for every colonoscopy performed. The data were recorded manually in a Microsoft Excel spreadsheet. The pathology of the polyp(s) was recorded and matched to each colonoscopy report. A feedback report was provided to each physician every 6 months. Results: A total of 4,309 patients were examined during the 2.5-year study period, from 7/2010 to 12/2012. The average age of the participants was 59.4 years. The mean ADR for 3rd quarter 2010 was 49%, while the mean ADR for 4th quarter 2012 was 62%. The 13% increase in mean ADR was statistically significant (p<0.0001). Between the same time periods, the mean withdraw time increased from 19.57 minutes to 24.67 minutes, which represented a statically significant increase (p<0.001). The mean scope insertion time was 7.62 minutes, and the mean scope withdraw time was 22.07 minutes over the 2.5-year study period. The mean ADR was 53.7% amongst the five physicians in our group throughout the study period. Moreover, the highest adenoma detector had an adenoma detection rate of 72% for two quarters in 2012 (see Physician 2 in Figure 1).FigureConclusion: 1. Bi-annual feedback of individual ADR can improve individual physician and overall group ADRs (Figure 1). 2. The majority of patients undergoing colonoscopy in our practice have adenomas, as evidenced by a mean ADR greater than 50% throughout the study period. 3. An increase in the ADR was correlated with an increase in withdraw time over the study period (Pearson r 0.31, p<0.0001). 4. Improvement in the quality of colonoscopy, as indicated by a higher ADR, appears to be associated with a withdraw time greater than 20 minutes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".