Effect of an educational intervention on colonoscopy quality outcomes
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and Other Interventional Techniques
2019 SAGES ORAL
Effect of an educational intervention on colonoscopy quality outcomes Bradley Evans1 · David Pace1 · Mark Borgaonkar2 · John Harnett2 · Matthew Miné‑Goldring3 · Melissa Meng Ge4 · Jane Brodie4 · Darryl Boone1 · Jerry McGrath1 Received: 25 February 2019 / Accepted: 28 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background We aimed to assess the effect of a colonoscopy skills improvement (CSI) course on quality indicators at our institution. Methods This retrospective cohort study included ten surgeons and nine gastroenterologists practicing in a tertiary referral center who had undergone CSI training between 2014 and 2015. Procedural data for 50 colonoscopies by each physician was collected immediately before and after CSI training, and again 8 months after training. The primary outcome was adenoma detection rate (ADR) and secondary outcomes included colonoscopy completion rate (CCR), and withdrawal time (WT). Univariate analysis followed by stepwise multivariable logistic regression was performed to assess for predictors of these outcomes. These variables included patient age, gender, indication for colonoscopy, quality of bowel preparation, and CSI training. Results 2533 colonoscopies were included. There was no improvement in ADR for the entire group immediately after training and at 8 months (31.8% vs. 33.6% vs. 35.3%, p = 0.319). In subgroup analysis, the ADR of surgeons improved non-significantly immediately after completing the course and increased further at 8 months (30.9% vs. 31.6% vs. 37.6%, p = 0.065). The same changes were not observed for the gastroenterology subgroup (32.9% vs. 36.0% vs. 32.8%, p = 0.550). No change was noted in CCR or WT. In multivariate analysis of the surgical subgroup, increased patient age, male gender, and the 8-month time point following CSI training were associated with higher ADR. Conclusion CSI training is associated with an improvement in ADR for surgeons at our institution. Keywords Colonoscopy · Quality improvement · Adenoma detection rate High quality colonoscopy plays a critical role in the early detection and prevention of colorectal cancer (CRC). Adenoma detection rate (ADR) is the only quality indicator for colonoscopy that has been clearly associated with risk of interval CRC and death [1, 2]. Other intra-procedure quality indicators include adequacy of bowel preparation, * Bradley Evans [email protected] 1
Department of Surgery, Memorial University, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6, Canada
2
Department of Medicine, Memorial University, St. John’s, Canada
3
Department of Surgery, McMaster University, Hamilton, Canada
4
Faculty of Medicine, Memorial University, St. John’s, Canada
colonoscopy completion rate (CCR), patient comfort, withdrawal time (WT) and sedation use [3]. Noting a significant variation in the quality of colonoscopy across Canada, The Canadian Association of Gastroenterology (CAG) developed the Skills Enhancement
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