Document Detail

An endoscopic quality improvement program improves detection of colorectal adenomas.
MedLine Citation:
PMID:  23295274     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Adenoma detection rate (ADR) is a key measure of quality in colonoscopy. Low ADRs are associated with development of interval cancer after "negative" colonoscopy. Uncontrolled studies mandating longer withdrawal time, and other incentives, have not significantly improved ADR. We hypothesized that an endoscopist training program would increase ADRs.
METHODS: Our Endoscopic Quality Improvement Program (EQUIP) was an educational intervention for staff endoscopists. We measured ADRs for a baseline period, then randomly assigned half of the 15 endoscopists to undergo EQUIP training. We then examined baseline and post-training study ADRs for all endoscopists (trained and un-trained) to evaluate the impact of training. A total of 1,200 procedures were completed in each of the two study phases.
RESULTS: Patient characteristics were similar between randomization groups and between study phases. The overall ADR in baseline phase was 36% for both groups of endoscopists. In the post-training phase, the group of endoscopists randomized to EQUIP training had an increase in ADR to 47%, whereas the ADR for the group of endoscopists who were not trained remained unchanged at 35%. The effect of training on the endoscopist-specific ADRs was estimated with an odds ratio of 1.73 (95% confidence interval 1.24-2.41, P=0.0013).
CONCLUSIONS: Our results indicate that ADRs can be improved considerably through simple educational efforts. Ultimately, a trial involving a larger number of endoscopists is needed to validate the utility of our training methods and determine whether improvements in ADRs lead to reduced colorectal cancer.
Susan G Coe; Julia E Crook; Nancy N Diehl; Michael B Wallace
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-01-08
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  108     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-05     Completed Date:  2013-03-22     Revised Date:  2014-01-20    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  219-26; quiz 227     Citation Subset:  IM    
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MeSH Terms
Adenoma / diagnosis*,  prevention & control
Colonoscopy / education*,  standards*,  trends
Colorectal Neoplasms / diagnosis*,  prevention & control
Diagnosis, Differential
Education, Medical, Continuing
Gastroenterology / education,  standards
Inservice Training*
Middle Aged
Odds Ratio
Operative Time*
Program Development
Quality Improvement*
Comment In:
Am J Gastroenterol. 2013 Dec;108(12):1929   [PMID:  24300865 ]
Am J Gastroenterol. 2013 Feb;108(2):228-30   [PMID:  23381073 ]
Am J Gastroenterol. 2013 Dec;108(12):1929-30   [PMID:  24300866 ]

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