1. Application of Next Generation Quality/Statistical Process Control and Expert-Led Case Review to Increase the Consistency of Diagnostic Rates in Precancerous Colorectal Polyps
- Author
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Asghar Naqvi, Jennifer M. Dmetrichuk, Michael Bonert, Sahar Al-Haddad, Pierre Major, Andrew Collins, and Ted Xenodemetropoulos
- Subjects
Adenoma ,medicine.medical_specialty ,Funnel plot ,Health (social science) ,Leadership and Management ,continuous quality improvement ,Colonic Polyps ,Methods and Instruments ,Statistical Process Control ,03 medical and health sciences ,0302 clinical medicine ,Tubular adenoma ,Consistency (statistics) ,pathologist diagnostic rate ,medicine ,Humans ,030212 general & internal medicine ,Care Planning ,business.industry ,030503 health policy & services ,Health Policy ,Gastrointestinal pathology ,Precancerous Polyp ,medicine.disease ,colorectal polyps ,Colorectal Polyp ,sessile serrated adenoma ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Radiology ,0305 other medical science ,business ,Colorectal Neoplasms ,Precancerous Conditions ,Kappa ,Sessile serrated adenoma - Abstract
Supplemental Digital Content is Available in the Text., Background: Prior work suggests high interrater variability in the pathologist diagnostic rate (PDR) of the precancerous polyp sessile serrated adenoma (SSA). Objectives: To improve the diagnostic consistency in the pathological evaluation of colorectal polyp specimens with diagnostic rate awareness, using funnel plots (FPs)/control charts (CCs), and a focused group case review. Methods: All colorectal polyp specimen (CRPS) reports September 2015 to August 2017 were analyzed at one institution. PDRs were extracted using a hierarchical free-text string matching algorithm and visualized using FPs, showing pathologist specimen volume versus PDR, and CCs, showing pathologist versus normed PDR. The FPs/CCs were centered on the group median diagnostic rate (GMDR). Pathologists were shown their baseline SSA diagnostic rate in relation to the practice, and in January 2017, there was a focused group case review/open discussion of approximately 40 sequential cases signed as SSA with a gastrointestinal pathology expert. Results: Nine pathologists interpreted more than 250 CRPSs per year. FPs/CCs for the first and second years showed 6/4 and 3/1 P < .05/P < .001 pathologist outliers, respectively, in relation to the GMDR for SSA and 0/0 and 0/0 P < .05/P < .001 pathologist outliers, respectively, in relation to the GMDR for tubular adenoma (TA). An in silico kappa (ISK) for SSA improved from 0.52 to 0.62. Conclusion: Diagnostic rate awareness facilitated by FPs/CCs coupled with focused expert-led reviews may help calibrate PDR. Variation in SSA PDRs still remains high in relation to TA. ISK represents an intuitive, useful metric and Next Generation Quality/Statistical Process Control a promising approach for objectively increasing diagnostic consistency.
- Published
- 2021