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Sa1119 Will Split Dosing of Bowel Preparation Improve Quality of Colonoscopy and Increase Colorectal Neoplasm Detection?
Sa1119 Will Split Dosing of Bowel Preparation Improve Quality of Colonoscopy and Increase Colorectal Neoplasm Detection? Gati Dhroove, Vishnu Naravadi, Gokulakrishnan Balasubramanian, Tedra Gray, Kris Anand Background- Adequate bowel preparation is an important element in screening colonoscopy. Bowel preparation with ingestion of polyethylene glycol(PEG)solution the evening before colonoscopy results in suboptimal cleansing and affects the diagnostic yield. The American College of Gastroenterology supports the concept of split dosing to enhance the efficacy of bowel preparation. Aims- To compare the efficacy of the bowel preparation with split dosing(SD)of polyethylene glycol(PEG)solution versus the conventional dosing(CD). Methods- Charts of 492 consecutive patients undergoing screening colonoscopy by a single endoscopist from January 2010 to October 2011 were reviewed. Of these, 243 patients had received SD bowel preparation(SD group)compared to 249 patients who had received CD bowel preparation(CD group).Data on patient demographics, quality of preparation,cecal intubation rate, polyp detection rate, adenoma detection rate and polyp histology were collected. Significant Colorectal Neoplasm(CRN)was defined as polyp > 1 cm in size,≥ 3 adenomas and those with villous histology. Right sided colon was defined as cecum, ascending colon, transverse colon. Left sided colon was defined as descending colon, sigmoid colon and the rectum. A weighted score was assigned to poor, sub-optimal and good quality of bowel preparation as determined by the endoscopist. Results: Table 1 lists the patient demographics in the two groups. Both groups were well-matched in terms of age, sex and ethnicity. Polyp detection rate was 40% in SD group vs.33% in CD group (p=0.09). There was no significant difference in adenoma detection rate (24% vs. 23%, p=0.87) and cecal intubation rate (98% vs. 97%, p=0.35) between two groups. Significant CRN detection rate on right side was 12% with SD group and 4% with CD group(p=0.028). On left side significant CRN detection rate was 7% with SD group and 6% with CD group. 2 colorectal cancers were detected in the SD group and none in CD group(Table 2). Bowel preparation score was 2.8 in SD group compared to 2.6 in CD group Conclusions: Both the groups had similar bowel preparation scores and cecal intubation rates. However, bowel preparation with split-dose PEG solution resulted in a trend towards a higher polyp detection rate though it did not meet statistical significance. The SD regimen was efficient in detecting more significant CRN on the right side compared to CD regimen. Table 1
Sa1121 Feasibility and Accuracy of Patients Reporting Quality-of-Life and Quality-ofCare Metrics Utilizing a Web-Based Patient-Centric Platform: A Model for Quality Improvement Initiatives Rubin Bahuva, Ashish Atreja, Jean-Paul Achkar, Bo Shen, Ahmed Kandiel, Bret Lashner, Aaron Brzezinski Introduction: Measuring and improving healthcare quality is an important national challenge, and a focus of recent healthcare reforms. However, measuring quality of care is expensive and burdensome. A more sustainable quality improvement model could be if we allow patients to report quality metrics by providing them tools to report and track quality metrics at the point-of-care and at home. We report the results from our prospective pragmatic trial regarding the feasibility and accuracy of utilizing patient reported outcomes (PRO) for determining quality indicators in CD patients. Methods: CrohnsPROMISE (Crohns Patient Reported Outcome and Medical Illness Severity Evaluation) is a patient centric web-based platform that allows Crohn's disease (CD) patients to enter data about their quality metrics and quality of life prospectively at http://crohnspromise.org. The patients are asked to answer a series of simple questions related to their symptoms, medications and investigations. The answers get summarized on a single screen as shown in the figure for quick review by the physician. We compared patient reported information to physician documentation and results in electronic health records (EHR) to determine concordance rates for different patient reported variables, quality indicators, CD disease phenotype and medication use. Results: 126 patients were enrolled and given individual password access for prospective entry of quality metrics at crohnspromise.org. 97% of patients (n=122) successfully entered data on the website. There is a high concordance rate between PRO and physician/EHR documentation for most of the quality metrics. The concordance was highest for age at diagnosis (87%), colonoscopy findings of dysplasia or cancer (>90%), smoking status (95%). The concordance was relatively low for knowledge about phenotype (54%) and osteoporosis evaluation (66%). Pilot trial is ongoing but interim analysis shows that patients in intervention arm have trend towards better quality of life. The final results of trial will be presented at DDW. Conclusion: Most of the CD patients can report quality indicators and quality-of-life data using a webbased tool, suggesting patient-centric CrohnsPROMISE framework can serve as a sustainable model for quality improvement for other chronic diseases including cirrhosis. While information on many quality indicators (including colonoscopy, findings of dysplasia or cancer, smoking, adherence and medication use) can be accurately captured from patients, there is high variability in few indicators such as CD phenotype which reflects deficits in patients' knowledge, physician documentation or both. A careful evaluation about accuracy of each quality metric reported by patients will be prerequisite as we start to leverage patient reported data for quality improvement efforts.
Sa1120 Gastroenterology Fellow Involvement and Level of Fellowship Training Increases Adenoma Detection Rate Rajan Kochar, Praveen Guturu, Roger D. Soloway, Sreeram V. Parupudi BACKGROUND: The adenoma detection rate (ADR) has emerged as an important quality indicator in screening and surveillance colonoscopies for colorectal cancer. The effect of involving gastroenterology fellows on ADR in screening colonoscopies is uncertain. AIM: To compare ADRs in screening colonoscopies performed with and without gastroenterology fellows, and to assess whether the year of fellowship training affects the ADR. METHODS: We performed a retrospective review of all average-risk screening colonoscopies performed
Crohns disease report card showing adherence to quality indicators and longitudinal assessment of quality of life (Short IBD Questionnaire)
S-221
AGA Abstracts
AGA Abstracts
by 3 experienced attending gastroenterologists at a tertiary care University Hospital between 2006 and 2011. A total of 1798 colonoscopies were included in the study, out of which 924 (51.4%) were performed by a gastroenterology fellow under supervision. Statistical analyses of polyp and adenoma detection were performed using chi-square test and logistic regression. RESULTS: A total of 874 (48.6%) screening colonoscopies were performed by the attending gastroenterologists alone, compared with 924 colonoscopies involving a gastroenterology fellow. The ADR was significantly higher [25.8% vs. 17.6%, p < 0.0001, Odds ratio (OR): 1.62 (95% C.I: 1.29 - 2.04)] among colonoscopies that included a gastroenterology fellow compared with those performed by attending gastroenterologists alone. Similarly, the polyp detection rate (PDR) was significantly higher [47,3% vs. 32.4%, p<0.00001, OR: 1.87 (95% C.I: 1.55 - 2.27)] in colonoscopies that involved a gastroenterology fellow. There was no difference in the detection of advanced adenomas (size > 1 cm, and/or presence of high grade dysplasia) or cancer between the fellow and non-fellow group. The ADR improved as the fellowship training level advanced from first year to second and third year. The ADR of colonoscopies performed by gastroenterology fellows in different years of training compared with those performed by gastroenterology attending alone are as follows: first year fellow - 20.5% vs. 17.6% (p = 0.5, OR: 1.2, 95% C.I: 0.78-1.86), second year fellow - 28.2% vs. 17.6% (p<0.0001, OR: 1.83, 95% C.I:1.4 - 2.41), third year fellow - 24.9% vs. 17.6% (p<0.01, OR: 1.58, 95% C.I: 1.17 - 2.13). Comparison of the ADR within the three groups of fellows separated by training year did not reach statistical significance; however, the ADR tended to increase after the first year of fellowship training. CONCLUSIONS: The adenoma detection rate increases with involvement of gastroenterology fellows in screening colonoscopies compared with those performed by attending gastroenterologists alone. The adenoma detection rate tends to improve with increasing level of gastroenterology fellowship training.
Sa1121 Feasibility and Accuracy of Patients Reporting Quality-of-Life and Quality-ofCare Metrics Utilizing a Web-Based Patient-Centric Platform: A Model for Quality Improvement Initiatives Rubin Bahuva, Ashish Atreja, Jean-Paul Achkar, Bo Shen, Ahmed Kandiel, Bret Lashner, Aaron Brzezinski Introduction: Measuring and improving healthcare quality is an important national challenge, and a focus of recent healthcare reforms. However, measuring quality of care is expensive and burdensome. A more sustainable quality improvement model could be if we allow patients to report quality metrics by providing them tools to report and track quality metrics at the point-of-care and at home. We report the results from our prospective pragmatic trial regarding the feasibility and accuracy of utilizing patient reported outcomes (PRO) for determining quality indicators in CD patients. Methods: CrohnsPROMISE (Crohns Patient Reported Outcome and Medical Illness Severity Evaluation) is a patient centric web-based platform that allows Crohn's disease (CD) patients to enter data about their quality metrics and quality of life prospectively at http://crohnspromise.org. The patients are asked to answer a series of simple questions related to their symptoms, medications and investigations. The answers get summarized on a single screen as shown in the figure for quick review by the physician. We compared patient reported information to physician documentation and results in electronic health records (EHR) to determine concordance rates for different patient reported variables, quality indicators, CD disease phenotype and medication use. Results: 126 patients were enrolled and given individual password access for prospective entry of quality metrics at crohnspromise.org. 97% of patients (n=122) successfully entered data on the website. There is a high concordance rate between PRO and physician/EHR documentation for most of the quality metrics. The concordance was highest for age at diagnosis (87%), colonoscopy findings of dysplasia or cancer (>90%), smoking status (95%). The concordance was relatively low for knowledge about phenotype (54%) and osteoporosis evaluation (66%). Pilot trial is ongoing but interim analysis shows that patients in intervention arm have trend towards better quality of life. The final results of trial will be presented at DDW. Conclusion: Most of the CD patients can report quality indicators and quality-of-life data using a webbased tool, suggesting patient-centric CrohnsPROMISE framework can serve as a sustainable model for quality improvement for other chronic diseases including cirrhosis. While information on many quality indicators (including colonoscopy, findings of dysplasia or cancer, smoking, adherence and medication use) can be accurately captured from patients, there is high variability in few indicators such as CD phenotype which reflects deficits in patients' knowledge, physician documentation or both. A careful evaluation about accuracy of each quality metric reported by patients will be prerequisite as we start to leverage patient reported data for quality improvement efforts.
Sa1120 Gastroenterology Fellow Involvement and Level of Fellowship Training Increases Adenoma Detection Rate Rajan Kochar, Praveen Guturu, Roger D. Soloway, Sreeram V. Parupudi BACKGROUND: The adenoma detection rate (ADR) has emerged as an important quality indicator in screening and surveillance colonoscopies for colorectal cancer. The effect of involving gastroenterology fellows on ADR in screening colonoscopies is uncertain. AIM: To compare ADRs in screening colonoscopies performed with and without gastroenterology fellows, and to assess whether the year of fellowship training affects the ADR. METHODS: We performed a retrospective review of all average-risk screening colonoscopies performed
Crohns disease report card showing adherence to quality indicators and longitudinal assessment of quality of life (Short IBD Questionnaire)
S-221
AGA Abstracts
AGA Abstracts
by 3 experienced attending gastroenterologists at a tertiary care University Hospital between 2006 and 2011. A total of 1798 colonoscopies were included in the study, out of which 924 (51.4%) were performed by a gastroenterology fellow under supervision. Statistical analyses of polyp and adenoma detection were performed using chi-square test and logistic regression. RESULTS: A total of 874 (48.6%) screening colonoscopies were performed by the attending gastroenterologists alone, compared with 924 colonoscopies involving a gastroenterology fellow. The ADR was significantly higher [25.8% vs. 17.6%, p < 0.0001, Odds ratio (OR): 1.62 (95% C.I: 1.29 - 2.04)] among colonoscopies that included a gastroenterology fellow compared with those performed by attending gastroenterologists alone. Similarly, the polyp detection rate (PDR) was significantly higher [47,3% vs. 32.4%, p<0.00001, OR: 1.87 (95% C.I: 1.55 - 2.27)] in colonoscopies that involved a gastroenterology fellow. There was no difference in the detection of advanced adenomas (size > 1 cm, and/or presence of high grade dysplasia) or cancer between the fellow and non-fellow group. The ADR improved as the fellowship training level advanced from first year to second and third year. The ADR of colonoscopies performed by gastroenterology fellows in different years of training compared with those performed by gastroenterology attending alone are as follows: first year fellow - 20.5% vs. 17.6% (p = 0.5, OR: 1.2, 95% C.I: 0.78-1.86), second year fellow - 28.2% vs. 17.6% (p<0.0001, OR: 1.83, 95% C.I:1.4 - 2.41), third year fellow - 24.9% vs. 17.6% (p<0.01, OR: 1.58, 95% C.I: 1.17 - 2.13). Comparison of the ADR within the three groups of fellows separated by training year did not reach statistical significance; however, the ADR tended to increase after the first year of fellowship training. CONCLUSIONS: The adenoma detection rate increases with involvement of gastroenterology fellows in screening colonoscopies compared with those performed by attending gastroenterologists alone. The adenoma detection rate tends to improve with increasing level of gastroenterology fellowship training.