P193 The national endoscopy database automated performance reports to improve quality outcomes trial (NED-APRIQOT): multi-centre randomised trial of polyp detection feedback

IntroductionPost-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK’s National Endoscopy Database (NED), which automatically captures data real-time, we assessed if providing feedback of case-mix-adjusted Mean Number of Polyps (aMNP), a key performance indicator (KPI), in a theory-informed and evidence-based behaviour change intervention improved endoscopists’ performance.MethodsThe multicentre, prospective NED Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) randomised NHS endoscopy centres to intervention or control arms. Intervention-arm endoscopists were emailed personalised and tailored monthly reports automatically generated within NED, informed by qualitative interviews and behaviour change theory. The primary outcome was endoscopists’ aMNP during the 9-month intervention.ResultsDuring November 2020-July 2021, 541 endoscopists across 36 centres (19 intervention; 17 control) performed 54,770 procedures during the intervention period, and 15,960 procedures during the 3-months post-intervention. Comparing intervention-arm to control-arm endoscopists during the intervention period: aMNP was 7% higher although not statistically significance (95% confidence interval (CI) -1% to 14%; p=0·08). Unadjusted MNP (10%, 95%CI 1–20%, p=0.04) and polyp detection rate (PDR) (10%, 95%CI 4–16%, p=0.002) were significantly higher. Differences were not maintained in the post-intervention period. The intervention effect on aMNP was modified by centre workload (estimated marginal mean aMNP between arms for low-workload centres: intervention 108.85 vs. control 92.75; high-workload centres: intervention 100.48 vs. control 102.5; p for interaction=0.01).Within the intervention-arm, endoscopists accessing NED-APRIQOT webpages had higher aMNP than those who did not (118 vs 102 aMNP, p=0.03). Intervention arm endoscopists prescribed hyoscine butylbromide in a larger proportion compared to the control group in both intervention and post-intervention periods (p