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.
- Aimed to improve the quality of colonoscopic polyp detection and resulting colorectal cancer outcomes in the UK.
- Used the National Endoscopy Database to identify variation in endoscopy performance, determine key performance indicators and develop automated feedback reports for endoscopists.
- Ran from April 2018 to April 2022.
Colorectal cancer (CRC) is diagnosed in half a million people each year in Europe and is the fourth most common cancer in the UK. Because CRC arises from polyps, their detection through colonoscopy is vital for preventing progression to malignancy.
International studies show significant differences in the number of polyps detected between colonoscopists, but the extent of this quality variation in the UK is unknown and difficult to evaluate.
This Newcastle University-led study used data from the National Endoscopy Database (NED), which automatically collects real-time endoscopy statistics from UK hospitals, to determine optimal key performance indicators (KPIs) for colonoscopic polyp detection and facilitate quality improvement.
A large randomised controlled trial involving 36 endoscopy services and 541 endoscopists investigated whether regular, automatic feedback on KPIs would improve performance. Participating endoscopists received a monthly NED-generated email, showing the adjusted mean number of polyps (aMNP) they had detected, along with colleague comparisons, targets and aspirational standards.
Although no statistically significant benefit was demonstrated in the main aMNP analysis (possibly because trial size was restricted due to the COVID-19 pandemic), additional analyses confirmed that automated feedback reports, which many endoscopists asked to continue receiving following the trial, improved performance quality overall.
Importantly, the study highlighted the need to investigate reduced polyp detection rates during weekends, and revealed the health economic and quality-of-life gains that could be achieved if standards increased within low-performing endoscopy services.
This project clearly demonstrated the benefits of implementing a learning health system with a robust, automated methodology that holds great potential in terms of expansion and transfer to other health sectors to improve clinical practice and patient outcomes.
Contact information
For more information about this project, please contact Professor Matt Rutter, Professor of Gastroenterology, University Hospital of North Tees.