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Colonoscopy Quality Data

About Colonoscopy Quality

We have a responsibility to our patients to be certain that our services are of the highest quality and safety. Our Clinical Quality Program includes tracking quality data for every colonoscopy we perform.  Results are regularly shared with our physicians and reviewed through our Peer Review Program.  The goal of this program is to continuously improve patient health outcomes.

Colonoscopy is one of the most frequently performed medical procedures with more than 14 million performed in the United States each year.  The procedure is especially valuable for both screening for colorectal cancer and follow-up of patients with a history of colorectal cancer or polyps.  Most colorectal cancer develops in a precancerous polyp (adenoma).  The detection and removal of adenomas through colonoscopy is the most important tool in the prevention of colorectal cancer.

Colonoscopy requires a high level of technical skill. Although generally safe, there is some risk of injury to the colon or bleeding. Studies demonstrate variation among physicians for several quality indicators of colonoscopy, among which are completion rates, pre-cancerous (adenoma) detection rates and withdrawal time.

Measuring and reporting clinical and procedural quality can help to highlight variation, increase transparency, and encourage internal quality improvement efforts. In addition, procedural quality data provides information that is relevant and useful for consumers in their health care choices.

Completion Rate Data

One important measure of colonoscopy quality is the completion rate:  defined as medical record documentation of whether or not the cecum (where the small intestine enters the colon) was reached during the colonoscopy.  Clinical guidelines recommend completion rates of >95% for average risk, screening colonoscopies and > 90% for all colonoscopies. 

How does CRSAL measure on completion rate?

CRSAL consistently outperforms national benchmark measures achieving colonoscopy completion rates of 99%.

Why does a complete colonoscopy matter? 

Polyps and colorectal cancer may acquire anywhere in the colon so it is important that the entire colon is examined. When colonoscopy exams are not complete to the end of the colon, or preparation for the exam was poor, patients must undergo additional procedures, such as x-rays to examine the unseen portion of the colon.  This increases expense, missed time from work and discomfort for patients.

Pre-Cancerous Polyp Detection Rate Data

We also measure adenoma (pre-cancerous polyp) detection rate: any tissue that is biopsied or removed during a colonoscopy is then examined by a pathologist. Polyps determined to be one of the following: an adenoma, tubular adenoma, villous adenoma, tubulovillous adenoma, sessile serrated adenoma, traditional sessile adenoma, and/or a mixed adenoma are included. The number of those polyps detected in all screening colonoscopies is used to calculate the adenoma detection rate.   Clinical guidelines recommend population-level adenoma detection rates of > 20% in women and > 30% in men. We also measure withdrawal times (time taken examining the colon as the colonoscope is removed) as withdrawal times of at least six minutes have been associated with higher polyp detection rates.

How does CRSAL measure on pre-cancerous polyp detection? 

CRSAL consistently outperforms national benchmark measures for pre-cancerous polyp detection achieving > 40% for women and > 50% for men.

Why does the polyp detection rate matter? 

The detection and removal of pre-cancerous polyps is the most important tool in the prevention of colorectal cancer.  Polyp detection rates can indicate the skill and thoroughness of the colonoscopist.

Withdrawal Time

Another quality indicator of colonoscopy is withdrawal time which is defined as the amount of time spent viewing as the colonoscope is withdrawn during a colonoscopy. A 6 minute withdrawal time is currently the standard of care.

Why does Withdrawal Time matter?

You want the physician performing your colonoscopy to do a complete and thorough exam.  Increasing the amount of time spent viewing during the withdrawal of the scope has been shown to affect the number of polyps found and increase the potential to detect adenomas (pre-cancerous) polyps. 

How does CRSAL measure on Withdrawal Time? 

CRSAL consistently achieves a withdrawal time = > 6 minutes for 99.7% of the colonoscopy procedures we perform.