Evaluation of the Estimated Adenoma Detection Rate (eADR) versus Polypectomy Rate (PR) for Quality Measurement of Colonoscopy

Abstract

Purpose: Several, easier to calculate, surrogates to ADR have been proposed. Endoscopists' PR calculated from US billings claims data has been shown to correlate well with ADR. We proposed using an adenoma to polyp detection rate quotient (APDRQ) to convert the PR to an eADR. The aim of this study was to determine whether an eADR derived from a small sample of pathology reports would be easy to use and more accurately estimate the ADR than PR from claims data alone. Methods: Data were collected on colonoscopies performed at an outpatient endoscopy center by 19 endoscopists in 2009. Endoscopist's had a minimum of 50 procedures. A PR was calculated using billing claims data CPT codes 45385, 45384, and 45380 along with polyp ICD9 code 211.3. The ADR was calculated for each endoscopist manually by reviewing all pathology reports. Finally, eADR was calculated by multiplying the APDRQ (determined by sample sizes of 25 and 50 pathology reports) with PR from billing data (eADR=APDRQ x PR). Pearson correlation coefficient was used to evaluate the relationship of each endoscopists' PR versus ADR and eADR versus ADR. Results: 5,382 colonoscopies were reviewed. Mean number of colonoscopies performed by each endoscopist was 275 (range 63-527). A significant relationship between endoscopists' PR and ADR was seen (r=0.85, P<.001) (Figure 1). A significant, but less closely correlated relationship was seen between eADR and ADR with 25 pathology reports (r=0.49, P=.008) and with 50 pathology reports reviewed (r=0.57, P=.002) (Figure 2).Figure 1: No Caption available.Figure 2: No Caption available.Conclusion: PR from claims data is a more accurate surrogate of ADR compared to eADR.