Simplifying Measurement of Adenoma Detection Rates for Colonoscopy
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ORIGINAL ARTICLE
Simplifying Measurement of Adenoma Detection Rates for Colonoscopy Andrew J. Gawron1,2,3 · Yiwen Yao2,4 · Samir Gupta5,6 · Garrett Cole2,4 · Mary A. Whooley7,8 · Jason A. Dominitz9,10 · Tonya Kaltenbach7,8 Received: 12 February 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Adenoma detection rate (ADR) is the colonoscopy quality metric with the strongest association to interval or “missed” cancer. Accurate measurement of ADR can be laborious and costly. Aims Our aim was to determine if administrative procedure codes for colonoscopy and text searches of pathology results for adenoma mentions could estimate ADR. Methods We identified US Veterans with a colonoscopy using Current Procedure Terminology (CPT) codes between January 2013 and December 2016 at ten Veterans Affairs sites. We applied simple text searches using Microsoft SQL Server full-text searches to query all pathology notes for “adenoma(s)” or “adenomatous” text mentions to calculate ADRs. To validate our identification of colonoscopy procedures, endoscopists of record, and adenoma detection from the electronic health record, we manually reviewed a random sample of 2000 procedure and pathology notes from the 10 sites. Results Structured data fields were accurate in identification of colonoscopies being performed (PPV = 0.99; 95% CI 0.99– 1.00) and identifying the endoscopist of record (PPV of 0.95; 95% CI 0.94–0.96) for ADR measurement. Simple text searches of pathology notes for adenoma mentions had excellent performance statistics as follows: sensitivity 0.99 (95% CI 0.98–1.00), specificity 0.93 (95% CI 0.92–0.95), NPV 0.99 (95% CI 0.98–1.00), and PPV 0.93 (0.91–0.94) for measurement of ADR. There was no clinically significant difference in the estimates of overall ADR vs. screening ADR (p > 0.05). Conclusions Measuring ADR using administrative codes and text searches from pathology results is an efficient method to broadly survey colonoscopy quality. Keywords Colonoscopy · Quality · Adenoma detection · Colon cancer screening Abbreviations CRC Colorectal cancer ADR Adenoma detection rate VA Veterans affairs
NLP Natural language processing EHR Electronic health record CDW Corporate data warehouse CPT Current procedure terminology
* Andrew J. Gawron [email protected]; [email protected]
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San Diego Veterans Affairs Health Care System, San Diego, CA, USA
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Division of Gastroenterology and the Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
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Measurement Science QUERI, San Francisco, CA, USA
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University of California San Francisco, San Francisco, CA, USA
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1
VA Salt Lake City Health Care System, Salt Lake City, UT, USA
Informatics, Decision‑Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine,
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