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Jones B, Scott FI, Espinoza J, Laborde S, Chambers M, Wani S, Edmundowicz S, Austin G, Pell J, Patel SG. Leveraging electronic medical record functionality to capture adenoma detection rate. Sci Rep 2022; 12:9679. [PMID: 35690660 PMCID: PMC9188587 DOI: 10.1038/s41598-022-13943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
Measuring the adenoma detection rate (ADR) is critical to providing quality care, however it is also challenging. We aimed to develop a tool using pre-existing electronic health record (EHR) functions to accurately and easily measure total ADR and to provide real-time feedback for endoscopists. We utilized the Epic EHR. With the help of an Epic analyst, using existing tools, we developed a method by which endoscopy staff could mark whether an adenoma was detected for a given colonoscopy. Using these responses and all colonoscopies performed by the endoscopist recorded in the EHR, ADR was calculated in a report and displayed to endoscopists within the EHR. One endoscopist piloted the tool, and results of the tool were validated against a manual chart review. Over the pilot period the endoscopist performed 145 colonoscopies, of which 78 had adenomas. The tool correctly identified 76/78 colonoscopies with an adenoma and 67/67 of colonoscopies with no adenomas (97.4% sensitivity, 100% specificity, 98% accuracy). There was no difference in ADR as determined by the tool compared to manual review (53.1% vs. 53.8%, p = 0.912). We successfully developed and pilot tested a tool to measure ADR using existing EHR functionality.
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Affiliation(s)
- Blake Jones
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Frank I Scott
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeannine Espinoza
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Sydney Laborde
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Micah Chambers
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sachin Wani
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Steven Edmundowicz
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory Austin
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Pell
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Swati G Patel
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA. .,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA. .,Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, 12631 E 17th Avenue, Room 7614, Campus Box 158, Aurora, CO, 80045, USA.
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Khong TL, Khoo XH, Hilmi I. A Systematic Review on the Effectiveness of Clinician-Directed Interventions to Improve Compliance to Post-Polypectomy Surveillance Guidelines. Dig Dis 2021; 40:654-664. [PMID: 34875650 DOI: 10.1159/000520859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Clinical practice guidelines recommend periodic colonoscopy surveillance following colorectal adenoma excision. Inappropriate use of post-polypectomy surveillance (PPS) is common and lead to improper resource utilization. The aim of this review was to identify structured interventions which can affect PPS practises and to evaluate the effectiveness of these various interventions in improving clinician adherence to PPS guidelines. METHODS A computerized search was performed to identify relevant studies between 1997 and November 2020. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the Newcastle-Ottawa risk of assessment scoring system. RESULTS The search identified 5,602 citations. Forty-one articles were retrieved for full-text analysis and 7 studies met the inclusion criteria. Compliance to PPS guidelines was higher following interventions which included medical education, specialist nurse coordinators facilitation, continuous quality improvement, and clinical decision support systems. CONCLUSION This study demonstrates that medical education, specialist nurse coordinators, continuous quality improvement, and clinical decision support systems are effective in improving clinicians' compliance to PPS guidelines, and are associated with reduction in over- and underutilization of colonoscopy surveillance resources.
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Affiliation(s)
- Tak Loon Khong
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Xin-Hui Khoo
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ida Hilmi
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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