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Adenoma Detection Rate: Have we gone too far?
Sameer D. Saini, MD, MS Associate Professor & Research Scientist University of Michigan Medical School
VA Center for Clinical Management Research Ann Arbor, MI
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Yes we have!
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“Not everything that counts can be counted, and not everything that can be counted counts.”
Sameer D. Saini
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“Not everything that counts can be counted, and not everything that can be counted counts.”
- Albert Einstein
Sameer D. Saini
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"Ultimately, the secret of quality is love … If you have love, you can then work backward to monitor and improve the system.”
Sameer D. Saini
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"Ultimately, the secret of quality is love … If you have love, you can then work backward to monitor and improve the system.”
- Avedis Donabedian
Sameer D. Saini
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“If [ADRs] are used for … QI, unadjusted rates may suffice... However, if [ADRs] are … used as the basis for rewarding or penalizing examiners, there will likely be a keen interest … in having as accurate an ADR measurement as possible.”
Sameer D. Saini
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“If [ADRs] are used for … QI, unadjusted rates may suffice... However, if [ADRs] are … used as the basis for rewarding or penalizing examiners, there will likely be a keen interest … in having as accurate an ADR measurement as possible.”
- Doug Corley
Sameer D. Saini
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Key Points
• Correlation ≠ classification
• Reliability matters
• The secret of quality is love!
Sameer D. Saini
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Correlation ≠ Classification
• High quality studies have shown that the ADR is associated with important clinical outcomes.
• But for accountability, we need to know how well the ADR performs as a diagnostic test.
Sameer D. Saini
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Correlation ≠ Classification
Duloy, et al. Clinical Gastroenterology and Hepatology 2019;17:691–700.
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Reliability matters
• In the real world, it is difficult to calculate a reliable ADR for 2 reasons:
– Inadequate numbers of patients
– Differences in patient populations
Sameer D. Saini
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Atkin, et al. Gastro 2004;126:1247–1256.
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The secret of quality is love!
• You cannot clone quality.
• Accountability measures do NOT generally improve performance.
• Often have unintended consequences…
Sameer D. Saini
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Sameer D. Saini