Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program

Abstract

Purpose: Quality indicators of the National Endoscopy Quality Improvement Program (NEQIP) and outcome measures of endoscopy in the National Cancer Screening Program (NCSP) in Korea are not clear. We evaluated the quality indicators of the revised NEQIP and outcome measures of endoscopy at different types of healthcare facilities participating in the NCSP. Materials and Methods: This study was conducted between March and August 2018 in primary, secondary, and tertiary healthcare facilities that perform endoscopy as a part of the NCSP. Representative endoscopists completed a questionnaire for quality indicators of the NEQIP and provided data on outcome measures for endoscopy. Results: Quality indicators of the NEQIP were mostly acceptable. However, the quality indicators for annual volume of esophagogastroduodenoscopy (EGD) and colonoscopy, training for endoscopy quality improvement by endoscopy nursing staff, colonoscopy reports, documentation of pathologic lesions, quality of endoscopy reprocessing areas, and completion of endoscopy reprocessing education programs were suboptimal. For outcome measures of EGD, the number of photo-documentations and total procedure time were higher at tertiary healthcare facilities than at other facilities (p<0.001 and p=0.023, respectively). For the outcome measures of colonoscopy, colonoscopy completion rate and waiting times for colonoscopy were significantly higher at tertiary healthcare facilities than at other facilities (both p<0.001). Conclusion: Outcome measures of endoscopy should be included as quality indicators of NCSP. However, universal outcome measures for all types of healthcare facilities should be established because performance levels of some outcome measures differ among individual healthcare facility types.

A Nationwide Survey on the Effectiveness of Training on Endoscope Reprocessing Within the National Cancer Screening Program&nbsp;

“…Unfortunately, however, 54.2% of participants in our study did not previously participate in the educational process, only 80.3% of them responded that they worked in accordance with the reprocessing guidelines. Moreover, previous studies conducting in NSCP have shown that 15-17% of physicians did not follow the reprocessing guidelines [18], and only 53.3% of nursing staff completed the reprocessing training program [11]. Therefore, based on the above ndings, we argue that endoscope reprocessing training should be conducted more actively to achieve better performance of endoscopy infection control throughout the country.…”

“…In Korea, the Korean Society of Gastrointestinal Endoscopy (KSGE) presented the rst endoscope reprocessing guidelines in 1995 and recently revised and published the third endoscope reprocessing guideline in 2015 [10]. Additionally, the National Endoscopy Quality Improvement Program included endoscope reprocessing to enhance the endoscopy unit quality by performing national cancer screening, which was introduced and revised in 2009 [10,11]; the Accredited Endoscopy Unit Program has recently been updated [12].…”

A nationwide survey on the effectiveness of training on endoscope reprocessing within the national cancer screening program in Korea

“…Moreover, previous studies conducted on the NSCP have shown that 15-17% of physicians did not follow the reprocessing guidelines, 23 and only 53.3% of nursing staff completed the reprocessing training program. 15 Based on the above findings, more than half of the workers in the endoscopy unit did not receive sufficient reprocessing training, although the training affected actual practice. Thus, adequate training should be provided to endoscopy workers to achieve better infection control related to endoscopic procedures throughout the country.…”

“…14 Additionally, the National Endoscopy Quality Improvement Program, introduced and revised in 2009, included endoscope reprocessing to enhance the endoscopy unit's capacity to perform national cancer screening. 14,15 The Accredited Endoscopy Unit Program has recently been updated. 16 Since 1999, gastric cancer endoscopic screening has been provided free of charge to individuals above age 40 every two years based on the high prevalence rate of gastric cancer.…”

Medico-legal implications for the colon perforation during colonoscopy

“…However the courts did not judge every case as a doctor's performance error. In general, it is known that doctors need to meet a minimum standard of colonoscopy experience to ensure the quality of colonoscopies 26,27 . However, even the most skilled doctors may not avoid colon perforation 28 , and some people are skeptical of requiring for minimal standards of colonoscopy experience 29,30 .…”