Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

Natalia S. Causada-Calo; Emmanuel I. Gonzalez-Moreno; Kirles Bishay; Risa Shorr; Catherine Dube; Steven J. Heitman; Robert J. Hilsden; Alaa Rostom; Catharine Walsh; John T. Anderson; Rajesh N. Keswani; Michael A. Scaffidi; Samir C. Grover; Nauzer Forbes

doi:10.1055/a-1221-4922

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1321-E1331
DOI: 10.1055/a-1221-4922

Original article

Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

Natalia S. Causada-Calo‡

¹Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada

,

Emmanuel I. Gonzalez-Moreno‡

²Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada

³Department of Community Health Sciences, University of Calgary, Calgary, Canada

,

Kirles Bishay

¹Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada

,

Risa Shorr

⁴Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Catherine Dube

⁵Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Canada

⁶Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

,

Steven J. Heitman

²Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada

³Department of Community Health Sciences, University of Calgary, Calgary, Canada

,

Robert J. Hilsden

²Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada

³Department of Community Health Sciences, University of Calgary, Calgary, Canada

,

Alaa Rostom

⁵Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Canada

⁶Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

,

Catharine Walsh

⁷Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute, and Research Institute, Hospital for Sick Children, Toronto, Canada

⁸The Wilson Centre, University of Toronto, Toronto, Canada

⁹Department of Pediatrics, University of Toronto, Toronto, Canada

,

John T. Anderson

¹⁰Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester, UK

,

Rajesh N. Keswani

¹¹Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, USA

,

Michael A. Scaffidi

¹Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada

,

Samir C. Grover

¹Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada

¹²Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada

,

Nauzer Forbes

²Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada

³Department of Community Health Sciences, University of Calgary, Calgary, Canada

› Institutsangaben

Abstract

Background and study aims The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists’ ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators.

Methods A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models.

Results From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI – 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses.

Conclusions Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.

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Referenzen

References
1 American Cancer Society. Key Statistics for Colorectal Cancer. Atlanta, GA: American Cancer Society; 2020 Accessed: 2020 May 22 https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
2 Vogelstein B, Fearon ER, Hamilton SR. et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988; 319: 525-532
3 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
4 Ran T, Cheng CY, Misselwitz B. et al. Cost-effectiveness of colorectal cancer screening strategies-a systematic review. Clin Gastroenterol Hepatol 2019; 17: 1969-1981.e1915
5 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110: 72-90
6 Rees CJ, Gibson TS, Rutter MD. et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923-1929
7 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
8 Singh S, Singh PP, Murad MH. et al. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1375-1389
9 Morris EJ, Rutter MD, Finan PJ. et al. Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service. Gut 2015; 64: 1248-1256
10 Kaminski MF, Gibson TS, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
11 Hilsden RJ, Rose SM, Dube C. et al. Defining and applying locally relevant benchmarks for the adenoma detection rate. Am J Gastroenterol 2019; 114: 1315-1321
12 Mehrotra A, Morris M, Gourevitch RA. et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc 2018; 87: 778-786.e775
13 Ezaz G, Leffler DA, Beach S. et al. Association between endoscopist personality and rate of adenoma detection. Clin Gastroenterol Hepatol 2019; 17: 1571-1579.e1577
14 Sanaka MR, Gohel T, Podugu A. et al. Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist. Dis Colon Rectum 2014; 57: 1113-1119
15 Heresbach D, Barrioz T, Lapalus MG. et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 2008; 40: 284-290
16 Facciorusso A, Triantafyllou K, Murad MH. et al. Compared Abilities of endoscopic techniques to increase colon adenoma detection rates: a network meta-analysis. Clin Gastroenterol Hepatol 2019; 17: 2439-2454.e2425
17 Forbes N, Mohamed R, Raman M. Learning curve for endoscopy training: Is it all about numbers?. Best Pract Res Clin Gastroenterol 2016; 30: 349-356
18 Shaukat A, Oancea C, Bond JH. et al. Variation in detection of adenomas and polyps by colonoscopy and change over time with a performance improvement program. Clin Gastroenterol Hepatol 2009; 7: 1335-1340
19 Rajasekhar PT, Rees CJ, Bramble MG. et al. A multicenter pragmatic study of an evidence-based intervention to improve adenoma detection: the Quality Improvement in Colonoscopy (QIC) study. Endoscopy 2015; 47: 217-224
20 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
21 The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa, ON: The Ottawa Hospital; 2019 Accessed: 2020 May 22 http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
22 Guyatt GH, Oxman AD, Vist GE. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926
23 Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011; 342: d549
24 Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration; 2011 Accessed: 2020 May 22 http://handbook-5-1.cochrane.org/front_page.htm
25 Egger M, Smith DG, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
26 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-1101
27 Coe SG, Crook JE, Diehl NN. et al. An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol 2013; 108: 219-226
28 Wallace MB, Crook JE, Thomas CS. et al. Effect of an endoscopic quality improvement program on adenoma detection rates: a multicenter cluster-randomized controlled trial in a clinical practice setting (EQUIP-3). Gastroint Endosc 2017; 85: 538-545
29 Kaminski MF, Anderson J, Valori R. et al. Leadership training to improve adenoma detection rate in screening colonoscopy: A randomised trial. Gut 2016; 65: 616-624
30 Keswani R, Yadlapati R, Gleason K. et al. Physician report cards and implementing standards of practice are both significantly associated with improved screening colonoscopy quality. Am J Gastroenterol 2015; 110: 1134
31 Hall B, Benson M, Pfau P. et al. Improved Adenoma detection rates at an academic gastroenterology unit following department colonoscopy assessment. Gastroint Endosc 2010; 71: AB107-108
32 Corley D, Jensen C, Lee J. et al. Increasing physician adenoma detection rate is associated with a reduced risk of post-colonoscopy colorectal cancer. Gastroenterology 2019; 156: S151
33 Berger D, Hubbard E, Greenspan M. et al. Non-neoplastic resection rate and adenoma detection rate increase after intervention to improve and monitor ADR. Gastroint Endosc 2017; 85: AB395
34 Evans B, Pace D, Borgaonkar M. et al. Effect of an educational intervention on colonoscopy quality outcomes. Surg Endosc 2019;
35 Rank J. Increased Adenoma Find Rate (AFR) and proportionately greater serrated adenoma find rate (safr) following a systematic quality improvement program in a large community gastroenterology practice. Gastroenterology 2011; 140: S199-200
36 Salden B, Bouwens M, Winkens B. et al. Systematic training improved the quality of colonoscopy by reducing the variation of quality indicators among providers. Gastroenterology 2012; 142: S2218
37 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
38 Bishay K, Causada-Calo N, Scaffidi MA. et al. Endoscopist feedback is associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis. Gastroint Endosc 2020; Online ahead of print.
39 Madhoun MF, Tierney WM. The impact of video recording colonoscopy on adenoma detection rates. Gastroint Endosc 2012; 75: 127-133
40 Scaffidi MA, Grover SC, Carnahan H. et al. A prospective comparison of live and video-based assessments of colonoscopy performance. Gastroint Endosc 2018; 87: 766-775
41 Waschke KA, Anderson J, Macintosh D. et al. Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol 2016; 30: 409-419
42 Peyton J. Teaching and learning in medical practice. Rickmansworth, UK: Manticore Europe Limited; 1998
43 Ekkelenkamp VE, Koch AD, de Man RA. et al. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65: 607-615
44 le Clercq CM, Bouwens MW, Rondagh EJ. et al. Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut 2014; 63: 957-963
45 Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ 2015; 351: h4672
46 Lim S, Hammond S, Park J. et al. Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis. Surg Endosc 2019;

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