Case-mix adjustment to compare colonoscopy performance between endoscopy centers: a nationwide registry study

Endoscopy, vol. 54, pp. 455–462

Abstract

Abstract Background Nonmodifiable patient and endoscopy characteristics might influence colonoscopy performance. Differences in these so-called case-mix factors are likely to exist between endoscopy centers. This study aimed to examine the importance of case-mix adjustment when comparing performance between endoscopy centers. Methods Prospectively collected data recorded in the Dutch national colonoscopy registry between 2016 and 2019 were retrospectively analyzed. Cecal intubation rate (CIR) and adequate bowel preparation rate (ABPR) were analyzed. Additionally, polyp detection rate (PDR) was studied in screening colonoscopies following a positive fecal immunochemical test (FIT). Variation in case-mix factors between endoscopy centers and expected outcomes for each performance measure were calculated per endoscopy center based on case-mix factors (sex, age, American Society of Anesthesiologist [ASA] score, indication) using multivariable logistic regression. Results 363 840 colonoscopies were included from 51 endoscopy centers. Mean percentages per endoscopy center were significantly different for age > 65 years, male patients, ASA ≥ III, and diagnostic colonoscopies (all P < 0.001). In the FIT-positive screening population, significant differences were observed between endoscopy centers for age > 65 years, male patients, and ASA ≥ III (all P ≤ 0.001). The expected CIR, ABPR, and PDR ranged from 95.0 % to 96.9 %, from 93.6 % to 96.4 %, and from 76.2 % to 79.1 %, respectively. Age, sex, ASA classification, and indication were significant case-mix factors for CIR and ABPR. In the FIT-positive screening population, age, sex, and ASA classification were significant case-mix factors for PDR. Conclusion Our findings emphasize the importance of considering case-mix adjustment when comparing colonoscopy performance measures between endoscopy centers.

Authors 8

1. Karlijn J. Nass Aachen Dutch Institute for Clinical Auditing

   Dutch Institute for Clinical Auditing · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

   Dutch Institute for Clinical Auditing, Leiden, The Netherlands

2. Manon V. Vlugt

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

3. Arthur K.E. Elfrink Aachen Dutch Institute for Clinical Auditing

   Dutch Institute for Clinical Auditing

   Affiliation as printed

   Dutch Institute for Clinical Auditing, Leiden, The Netherlands

4. Crispijn L. van den Brand Aachen Dutch Institute for Clinical Auditing

   Dutch Institute for Clinical Auditing

   Affiliation as printed

   Dutch Institute for Clinical Auditing, Leiden, The Netherlands

5. Janneke A. Wilschut Aachen Dutch Institute for Clinical Auditing

   Dutch Institute for Clinical Auditing

   Affiliation as printed

   Dutch Institute for Clinical Auditing, Leiden, The Netherlands

6. Paul Fockens

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

7. Evelien Dekker

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

8. Michel W.J.M. Wouters Aachen Department of Biomedical Data Sciences Dutch Institute for Clinical Auditing

   Leiden University Medical Center · The Netherlands Cancer Institute · Dutch Institute for Clinical Auditing

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

   Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands

   Dutch Institute for Clinical Auditing, Leiden, The Netherlands