Background and Aims

Although colonoscopy reduces colorectal cancer (CRC) risk, interval CRCs (iCRCs) still occur. We aimed to determine iCRC incidence, assess the relationship between adenoma detection rates (ADRs) and iCRC rates, and evaluate iCRC rates over time concomitant with initiation of an institutional colonoscopy quality improvement (QI) program.

Methods

We performed a retrospective cohort study of patients who underwent colonoscopy at an academic medical center (January 2003 to December 2015). We identified iCRCs through our data warehouse and reviewed charts to confirm appropriateness for study inclusion. iCRC was defined as a cancer diagnosed 6 to 60 months and early iCRC as a cancer diagnosed 6 to 36 months after index colonoscopy. We measured the relationship between provider ADRs and iCRC rates and assessed iCRC rates over time with initiation of a QI program that started in 2010.

Results

A total of 193,939 colonoscopies were performed over the study period. We identified 186 patients with iCRC. The overall iCRC rate was .12% and the early iCRC rate .06%. Average-risk patients undergoing colonoscopy by endoscopists in the highest ADR quartile (34%-52%) had a 4-fold lower iCRC risk (relative risk, .23; 95% confidence interval, .11-.48) than those undergoing colonoscopy by endoscopists in the lowest quartile (12%-21%). After QI program initiation, overall iCRC rates improved from .15% to .08% (P < .001) and early iCRC rates improved from .07% to .04% (P = .004).

Conclusions

We confirmed that iCRC rate is inversely correlated with provider ADR. ADRs increased and iCRC rates decreased over time, concomitant with a QI program focused on split-dose bowel preparation, quality metric measurement, provider education, and feedback. iCRC rate measurement should be considered a feasible, outcomes-driven institutional metric of colonoscopy quality.

中文翻译：

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质量改进计划后，改善的腺瘤检出率与间隔大肠癌发生率之间的关联。

背景和目标

尽管结肠镜检查可以降低结直肠癌（CRC）的风险，但间隔性CRC（iCRC）仍然会发生。我们旨在确定iCRC发生率，评估腺瘤检出率（ADR）与iCRC率之间的关系，并随着机构结肠镜检查质量改善（QI）计划的启动，评估iCRC随时间推移的发生率。

方法

我们对学术医疗中心（2003年1月至2015年12月）接受结肠镜检查的患者进行了回顾性队列研究。我们通过数据仓库识别了iCRC，并查看了图表以确认是否适合纳入研究。将iCRC定义为在结肠镜检查后6至60个月内诊断出的癌症，将iCRC定义为在结肠镜检查后6至36个月内诊断出的癌症。我们测量了提供方ADR与iCRC比率之间的关系，并随着2010年开始的QI计划随时间评估了iCRC比率。

结果

在研究期间共进行了193,939例结肠镜检查。我们确定了186名iCRC患者。红十字国际委员会的总体患病率为0.12％，早期红十字国际委员会的患病率为0.06％。由内镜医师在最高ADR四分位数中接受结肠镜检查的平均风险患者（34％-52％）与接受结肠镜检查的患者相比，iCRC风险降低了4倍（相对风险为.23； 95％置信区间为.11-.48）由内镜医师在最低四分位数（12％-21％）中进行。QI计划启动后，总体iCRC发生率从0.15％提高至.08％（P  <.001），早期iCRC发生率从.07％提高至.04％（P  = .004）。

结论

我们证实，iCRC率与提供商ADR成反比。随着时间的推移，ADR增加且iCRC率降低，同时开展的QI计划侧重于分剂量肠道准备，质量指标测量，提供者教育和反馈。iCRC率测量应被认为是可行的，以结果为导向的结肠镜检查质量的制度指标。