IMPROVING ADENOMA DETECTION RATE THROUGH FEEDBACK, EDUCATION, AND INCENTIVE - A QUALITY IMPROVEMENT INITIATIVE

Introduction: Colonoscopy is the gold standard for colorectal cancer (CRC) screening and multiple metrics are used to define colonoscopy quality. The most widely utilized and validated is the adenoma detection rate (ADR), defined as percentage of screening colonoscopies performed on patients aged 50 to 75 in which at least 1 adenoma is found. Target ADR to minimize interval CRC development is generally accepted as above 25%. Studies have shown a 1% increase in ADR is associated with 3% and 5% reduction in risk of CRC development and death, respectively. This has led to multiple initiatives and interventions being studied to improve endoscopists’ ADRs. Utilizing combinations of techniques including data availability, incorporating target ADRs to bonus compensation, and implementing an ADR educational session, we aimed to improve our network’s ADR to above 40%.

Methods: Through a 3 year period, we utilized 3 main interventions to improve ADR. First, we made our EMR’s automated ADR tracking available to individual endoscopists and introduced a network wide group ADR target for bonus compensation (7/1/2019). Second, we changed the physician incentive model from group to individual ADR (7/1/2021). Third, we incorporated an ADR improvement education session into a network wide divisional meeting (10/27/22). Statistical analysis was done on ADR means pre and post each intervention with t tests, and overall trends were analyzed with linear graphs and statistical control charts. When a full year's worth of data was not available (pre intervention 1 and post intervention 3), all available data were used (2 months and 5 months, respectively).

Results: Pre and Post Intervention Comparisons (Table 1) showed that all interventions had an increased ADR after deployment. However only individual financial incentives resulted in a statistically significant difference (38.5% to 40.8%, p=0.02). We analyzed the pre and post deployment trend lines for this intervention, and noted an increased R squared value from 0.0106 to 0.1162. Our statistical control chart showed overall up shift in ADR from Q4 2021 to the end of our study period, Q1 2023. Our group ADR increased from a baseline of 38.4% in fiscal year 2019 to 44.5% in fiscal year 2023 (Figure 1).

Conclusions: Individual incentives showed a significant effect on improving ADR. Group incentives and educational session deployment showed a non-statistically significant increase in ADR. Additional metrics to be studied include device use during endoscopy, such as endocuff, and the use of AI in endoscopy with technologies such as GI Genius, both of which have also been deployed in our network.