NED-APRIQOT – National Endoscopy Database: Automated Performance Reports to Improve Quality Outcomes Trial

Newcastle University

  • Led by Newcastle University, in partnership with the Joint Advisory Group on Gastrointestinal Endoscopy.
  • Aims to improve colonoscopy polyp detection in the UK, and so improve outcomes.
  • Will use the National Endoscopy Database to identify unwarranted variation in endoscopy performance, determine what the optimal key performance indicators and minimum standards should be, and develop automated feedback of performance to endoscopists and endoscopy units.
  • A three-year project starting in March 2018.

Colonoscopy is the key diagnostic investigation for colorectal cancer. However, international studies show a significant variation in quality between colonoscopists. Low polyp-detecting colonoscopists have higher post-procedure colorectal cancer incidence and mortality rates.

It is not currently known what the extent of the variation is in the UK, nor what the optimal key performance indicators (KPIs) for colonoscopy polyp detection should be. This means underperformance can’t be easily identified.

The National Endoscopy Database, overseen by the Joint Advisory Group on Gastrointestinal Endoscopy, will automatically captures real-time clinical data from each UK hospital’s Endoscopy Reporting System. This project will use the database to determine the optimal KPI for colonoscopy pathology detection.

This involves reviewing the evidence base for various suggested KPIs in this domain, and determining the confounders and explanatory factors for variation in optimal detection.

The project will also evaluate what the KPI minimum standard for proximal colon pathology detection should be. Proximal colorectal cancers are missed over twice as often as distal cancers.

The extent of unwarranted variation in endoscopy performance will be assessed, and potentially remediable factors identified. High and low performing Trusts will be identified, and a health economic analysis will be carried out to assess the impact of this variation.

A randomised controlled trial will be performed to find out what the impact of regular, unit-level performance data is. Automated KPI data reports will be produced and disseminated to the intervention group, including benchmarking against other endoscopists and units.

These high-quality, benchmarked endoscopy performance reports will allow endoscopists, providers and commissioners to identify potential issues rapidly.

Qualitative work will inform the design and implementation of the trial, to maximise the efficacy of the intervention. Additional interviews to be conducted after the trial will help with the interpretation of the findings.

This is a project run by a Joint Advisory Group on Gastrointestinal Endoscopy with Newcastle University. Follow the group via these accounts:

Contact information

For more information about this project, please contact Professor Matt Rutter, Professor of Gastroenterology, University Hospital of North Tees.

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