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Assessing USAF Primary Care Colonoscopy Training and Outcomes Using Quality Indicators. Brian Crownover, M.D., FAAFP Ethan Zimmerman, M.D. Family Medicine Residency Nellis AFB, NV. Goals of QI review. Describe training experience of Family Medicine colonoscopy trainers in USAF
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Assessing USAF Primary Care Colonoscopy Training and Outcomes Using Quality Indicators Brian Crownover, M.D., FAAFP Ethan Zimmerman, M.D. Family Medicine Residency Nellis AFB, NV
Goals of QI review • Describe training experience of Family Medicine colonoscopy trainers in USAF • Use outcomes based indicators to represent quality of USAF primary care colonoscopy • Measure results against national standard quality indicators
USAF Primary Care Endoscopists • Who? • Teaching faculty at 4 US Air Force Family Medicine residency locations who perform colonoscopy • NW Florida, N Calif, Las Vegas, St Louis • What? • Type and amount of training received • Self-collected procedure log data – post training
Primary Quality Indicators • Adenoma Detection Rate • Cecal Intubation Rate • Recommended ≥ 95% for screening colonoscopy
Primary Care Endoscopy • Why evaluate quality indicators? • Primary care under attack from Gastroenterology • Polypectomy reduces CRC mortality 53% • NEJM 2012; 366(8):687 • Only 65% Americans receive appropriate CRC screening • https://healthmeasures.aspe.hhs.gov/measure/25
Ko et al. • “Polyp detection and removal rates were significantly lower for nongastroenterologists than gastroenterologists”
ACG/AGA/ASGE – ADR Working Gp • Screening Colonoscopy Adenoma Detection Rate Measure- Draft: Public Comment (6/2012) • Numerator: Number of patients age 50‐75 with at least one adenoma detected during screening • Denominator: Patients age 50‐75 undergoing a screening colonoscopy • Exclusions: Incomplete colonoscopy • Measure: The percentage of patients age 50‐75 with at least one adenoma detected
Published GI Norms (PDR Surrogate for ADR) To attain the established benchmark ADRs for men (25%) and women (15%), endoscopists needed PDRs of 40% and 30%, respectively. PRs correlated well with ADRs (r(s) = 0.86, P < .001).
Published GI Norms Data reported in arbitrary group thresholds, not comparable to other published data
Correlations • Training experience to ADR • No correlation to receipt of simulator training Fisher's Exact Test (two-sided) p-value = 0.083 • No correlation to CME conference attendance Fisher's Exact Test (two-sided) p-value = 0.4755
Correlations with ADR Bottom line: No significant correlation with independent factors and ADR
Take home points • Recently trained faculty working with residents achieve high quality ADR rates (27.8%) comparable to published GI and FM numbers • Mean 2.6 years experience, 207 cases post training (117 cases in training) • Complications rates were low • No correlations were found between training experience variables and ADR
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