Measurement of polypectomy rate by using administrative claims data with validation against the adenoma detection rate

• Published in: Gastrointestinal endoscopy Vol. 77; no. 3; pp. 390 - 394
• Main Authors: Patel, Neal C., MD, Islam, Rafiul S., MD, Wu, Qing, ScD, Gurudu, Suryakanth R., MD, Ramirez, Francisco C., MD, Crowell, Michael D., MD, Faigel, Douglas O., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.03.2013
• Subjects: Adenoma - diagnosis; Adult; Aged; Aged, 80 and over; Colonic Polyps - diagnosis; Colonic Polyps - surgery; Colonoscopy - standards; Colonoscopy - statistics & numerical data; Colorectal Neoplasms - diagnosis; Female; Gastroenterology and Hepatology; Humans; Insurance, Health - statistics & numerical data; Male; Middle Aged; Retrospective Studies; adenoma detection rate; ICD-9; PR; International Classification of Diseases, Ninth Revision; current procedural terminology; MERGE; CPT; Mayo Electronic Record for Gastrointestinal Endoscopy; polypectomy rate; ADR
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.09.032

Background The adenoma detection rate (ADR) is a main quality indicator in colonoscopy but has many challenges for calculating. The polypectomy rate (PR) may be calculable from administrative claims data, but this has not been validated against the ADR. Objective To determine whether a PR calculated from United States billing claims data is an accurate surrogate for the ADR. Design A PR was calculated by using billing claims data from Current Procedural Terminology codes. The ADR was calculated for each endoscopist by using an endoscopy report database to which the pathology report data had been added. The relationship between PR and ADR was evaluated with the Pearson correlation coefficient. The ADR was plotted against the PR by individual endoscopist, and a least-squares regression line was created. A t test was used to analyze the differences in lesion detection between endoscopists with a PR above and below the benchmark PR. Setting Tertiary-care, outpatient endoscopy center. Patients All ages undergoing colonoscopy. Main Outcome Measurements PR and ADR. Results A total of 5382 colonoscopies were reviewed. A significant relationship between endoscopists' calculated PRs and ADRs was seen ( r = 0.85; P < .001). Endoscopists needed a PR of 35% to achieve the recommended benchmark ADR of 20%. Endoscopists with PRs of 35% or greater had an ADR of 27% (6.2 standard deviation [SD]) as compared with 19% (1.9 SD) for those with PRs less than 35% ( P = .0029). Limitations Study population. Conclusion Calculated PR from billing claims data is an accurate surrogate for ADR and may become an important quality measure for external and internal use.