Abstract：
OBJECTIVE: Postcolonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK\'s National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted mean number of polyps (aMNP), as a key performance indicator, improved endoscopists\' performance. Feedback was delivered via a theory-informed, evidence-based audit and feedback intervention.
METHODS: This multicenter, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial randomized National Health Service endoscopy centers to intervention or control. Intervention-arm endoscopists were e-mailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behavior change theory. The primary outcome was endoscopists\' aMNP during the 9-month intervention.
RESULTS: From November 2020 to July 2021, 541 endoscopists across 36 centers (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-month postintervention period. Comparing the intervention arm with the control arm, endoscopists during the intervention period: aMNP was nonsignificantly higher (7%; 95% CI, -1% to 14%; P = .08). The unadjusted MNP (10%; 95% CI, 1%-20%) and polyp detection rate (10%; 95% CI, 4%-16%) were significantly higher. Differences were not maintained in the postintervention period. In the intervention arm, endoscopists accessing NED Automated Performance Reports to Improve Quality Outcomes Trial webpages had a higher aMNP than those who did not (aMNP, 118 vs 102; P = .03).
CONCLUSIONS: Although our automated feedback intervention did not increase aMNP significantly in the intervention period, MNP and polyp detection rate did improve significantly. Engaged endoscopists benefited most and improvements were not maintained postintervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback.
BACKGROUND: www.isrctn.org ISRCTN11126923 .
METHODS: This multicenter, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial randomized National Health Service endoscopy centers to intervention or control. Intervention-arm endoscopists were e-mailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behavior change theory. The primary outcome was endoscopists\' aMNP during the 9-month intervention.
RESULTS: From November 2020 to July 2021, 541 endoscopists across 36 centers (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-month postintervention period. Comparing the intervention arm with the control arm, endoscopists during the intervention period: aMNP was nonsignificantly higher (7%; 95% CI, -1% to 14%; P = .08). The unadjusted MNP (10%; 95% CI, 1%-20%) and polyp detection rate (10%; 95% CI, 4%-16%) were significantly higher. Differences were not maintained in the postintervention period. In the intervention arm, endoscopists accessing NED Automated Performance Reports to Improve Quality Outcomes Trial webpages had a higher aMNP than those who did not (aMNP, 118 vs 102; P = .03).
CONCLUSIONS: Although our automated feedback intervention did not increase aMNP significantly in the intervention period, MNP and polyp detection rate did improve significantly. Engaged endoscopists benefited most and improvements were not maintained postintervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback.
BACKGROUND: www.isrctn.org ISRCTN11126923 .
摘要：
目的：息肉检出率低的内镜医师结肠镜检查后结直肠癌的发病率和死亡率较高。使用英国的国家内窥镜数据库（NED），自动捕获实时数据，我们评估是否提供病例混合调整的息肉平均数(aMNP)的反馈，作为关键绩效指标，改善内窥镜医师的表现。反馈是通过基于理论的循证审计和反馈干预来提供的。
方法：这个多中心，prospective,NED自动绩效报告以提高质量结果试验（NED-APRIQOT）随机NHS内窥镜检查中心进行干预或控制。在NED中自动生成的干预手臂内窥镜医师通过电子邮件发送定制的月度报告，由定性访谈和行为改变理论提供信息。主要结果是9个月干预期间的内窥镜医师aMNP。
结果：从2020年11月至2021年7月，来自36个中心（19个干预；17个对照）的541个内窥镜医师在干预期间执行了54,770个程序，以及干预后3个月内的15,960个程序。在干预期间，将干预臂与控制臂内窥镜医师进行比较：aMNP没有显着升高（7％，95%置信区间(CI)-1%至14%；p=0·08)。未调整的MNP(10%，95CI1-20%)和息肉检出率(PDR)(10%，95CI4-16%)显著较高。干预后的差异没有维持。在干预臂中，访问NED-APRIQOT网页的内窥镜医师的aMNP高于未访问者（118vs102aMNP，p=0.03)。
结论：尽管我们的自动反馈干预在干预期间并未显着增加aMNP，但MNP和PDR确实显着改善。参与的内窥镜医师受益最大，干预后未保持改善；未来的工作应解决反馈的参与问题，并考虑持续反馈的有效性。www.isrctn.orgISRCTN11126923。
方法：这个多中心，prospective,NED自动绩效报告以提高质量结果试验（NED-APRIQOT）随机NHS内窥镜检查中心进行干预或控制。在NED中自动生成的干预手臂内窥镜医师通过电子邮件发送定制的月度报告，由定性访谈和行为改变理论提供信息。主要结果是9个月干预期间的内窥镜医师aMNP。
结果：从2020年11月至2021年7月，来自36个中心（19个干预；17个对照）的541个内窥镜医师在干预期间执行了54,770个程序，以及干预后3个月内的15,960个程序。在干预期间，将干预臂与控制臂内窥镜医师进行比较：aMNP没有显着升高（7％，95%置信区间(CI)-1%至14%；p=0·08)。未调整的MNP(10%，95CI1-20%)和息肉检出率(PDR)(10%，95CI4-16%)显著较高。干预后的差异没有维持。在干预臂中，访问NED-APRIQOT网页的内窥镜医师的aMNP高于未访问者（118vs102aMNP，p=0.03)。
结论：尽管我们的自动反馈干预在干预期间并未显着增加aMNP，但MNP和PDR确实显着改善。参与的内窥镜医师受益最大，干预后未保持改善；未来的工作应解决反馈的参与问题，并考虑持续反馈的有效性。www.isrctn.orgISRCTN11126923。
