A randomized controlled trial of an audit and feedback report to improve colonoscopy performance

This project aims to measure the impact of a physician report card (also called an audit & feedback report) on colonoscopy performance. Colonoscopy is done using a long skinny tube with a light and camera on the end. It is inserted through the anus into the bowel and is used to diagnose colorectal (bowel) cancer. It can also be used to remove precancerous growths called polyps. Thus, colonoscopy is critical for colorectal cancer prevention. Physicians who do colonoscopy are called ?endoscopists?. Unfortunately, quality of colonoscopy varies depending on who is performing it. During colonoscopy, precancerous growths, called polyps or adenomas, can be diagnosed and removed. Poor quality colonoscopy may fail to identify and remove these precancerous growths, leading to missed colorectal cancer and avoidable cancer deaths. In Dr Tinmouth?s previous research, she developed an individualized endoscopist report card that summarizes their colonoscopy performance, in the hope that it would allow practitioners to assess and adjust their performance, thereby improving the quality of colonoscopy. Report cards have been used successfully to improve quality and safety in other healthcare fields. In this study, she and her team will investigate if the endoscopist report card actually improves colonoscopy performance. Endoscopists in Ontario will be randomly assigned to either receive the endoscopist report card or to receive no feedback. Using Ontario health administrative data, the quality of colonoscopy will be compared between those who received the report card and those who do not. The research team will also measure the effect of receiving the endoscopist report card on colonoscopy performance amongst endoscopists who perform poorly at baseline compared to those who do not. Further, the researchers will test the acceptability of two other educational interventions that aim to improve the quality of colonoscopy. The study aims to improve the quality of colonoscopy and potentially decrease the rate of missed colorectal cancers. The results will inform implementation of a centralized quality improvement initiative with potential to improve colonoscopy quality for an entire population. This study is critical to ensure that Canadians have access to the highest quality colonoscopy possible, to improve colorectal cancer prevention efforts.