Stability of Increased Adenoma Detection at Colonoscopy. Follow-Up of an Endoscopic Quality Improvement Program-EQUIP-II

Abstract

This study provides evidence that improvements in ADR obtained through the endoscopic quality-training program can persist for at least 5 months after completion of the program. It further suggests that a focus on ADR does not lead to a "one and done" phenomenon. The limitations of this study were as follows: single-center setting, and lack of sessile polyp information/standardization.

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“…geneity of intervention, participants, and practice environment [5, 14 -16]. Most recently, the endoscopic quality improvement project (EQUIP) demonstrated sustained improvement in ADR via implementation of two 1-hour educational programs, access to educational material, and monthly ADR feedback [17,18]. The impact was similar when adenomas per patient were analyzed.…”

“…The success of the EQUIP trial may begin to highlight a non-performance-based interven- ADR, adenoma detection rate; CWT, cecal withdrawal time; OR, odds ratio. tion that can provide such impact [17,18]. But the question will persist until ample evidence is available, can a low-ADR performer become a high-ADR provider.…”

What makes a “good” colonoscopy quality indicator?

“…Finally, to address the significant variation in endoscopists’ ADRs within the same practice groups, several studies have developed endoscopist education and training tools for colonoscopy quality improvement projects. 16,17 …”

“…7,20 In addition, Ussui et al have shown consistent and durable improvement in both screening and surveillance ADRs of low-performing endoscopists who underwent an intense endoscopic education and training intervention. 17 Therefore, given this high correlation between screening and surveillance ADRs and its likelihood of only providing a marginal benefit, measuring surveillance ADR as a separate quality indicator may not be necessary at this time.…”

Factors influencing variation in physician adenoma detection rates: a theory-based approach for performance improvement

“…9 Videorecording colonoscopy withdrawals and use of periodic report cards on colonoscopy quality measures may offer promise. 12,13 Also, more recently, an educational intervention focused on techniques for performing meticulous examinations and identifying adenomas was shown to improve detection rates, 14,15 although similar types of training were not successful in other studies, even when combined with interventions such as feedback, minimum withdrawal times, and financial incentives. 16-18 The poor performance of most interventions attempted may be related to the paucity of evidence on appropriate factors to target for modification.…”