RESUMO
BACKGROUND & AIMS: Postcolonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted mean number of polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed, evidence-based audit and feedback intervention. METHODS: This multicenter, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial randomized National Health Service endoscopy centers to intervention or control. Intervention-arm endoscopists were e-mailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behavior change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention. RESULTS: From November 2020 to July 2021, 541 endoscopists across 36 centers (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-month postintervention period. Comparing the intervention arm with the control arm, endoscopists during the intervention period: aMNP was nonsignificantly higher (7%; 95% CI, -1% to 14%; P = .08). The unadjusted MNP (10%; 95% CI, 1%-20%) and polyp detection rate (10%; 95% CI, 4%-16%) were significantly higher. Differences were not maintained in the postintervention period. In the intervention arm, endoscopists accessing NED Automated Performance Reports to Improve Quality Outcomes Trial webpages had a higher aMNP than those who did not (aMNP, 118 vs 102; P = .03). CONCLUSIONS: Although our automated feedback intervention did not increase aMNP significantly in the intervention period, MNP and polyp detection rate did improve significantly. Engaged endoscopists benefited most and improvements were not maintained postintervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback. CLINICAL TRIALS REGISTRY: www.isrctn.org ISRCTN11126923 .
RESUMO
INTRODUCTION: Patients with inflammatory bowel diseases (IBDs) of the colon are at an increased risk of colorectal cancer (CRC). This study investigates the epidemiology of IBD-CRC and its outcomes. METHODS: Using population data from the English National Health Service held in the CRC data repository, all CRCs with and without prior diagnosis of IBD (Crohn's, ulcerative colitis, IBD unclassified, and IBD with cholangitis) between 2005 and 2018 were identified. Descriptive analyses and logistic regression models were used to compare the characteristics of the 2 groups and their outcomes up to 2 years. RESULTS: Three hundred ninety thousand six hundred fourteen patients diagnosed with CRC were included, of whom 5,141 (1.3%) also had a previous diagnosis of IBD. IBD-CRC cases were younger (median age at CRC diagnosis [interquartile range] 66 [54-76] vs 72 [63-79] years [ P < 0.01]), more likely to be diagnosed with CRC as an emergency (25.1% vs 16.7% [ P < 0.01]), and more likely to have a right-sided colonic tumor (37.4% vs 31.5% [ P < 0.01]). Total colectomy was performed in 36.3% of those with IBD (15.4% of Crohn's, 44.1% of ulcerative colitis, 44.5% of IBD unclassified, and 67.7% of IBD with cholangitis). Synchronous (3.2% vs 1.6% P < 0.01) and metachronous tumors (1.7% vs 0.9% P < 0.01) occurred twice as frequently in patients with IBD compared with those without IBD. Stage-specific survival up to 2 years was worse for IBD-associated cancers. DISCUSSION: IBD-associated CRCs occur in younger patients and have worse outcomes than sporadic CRCs. There is an urgent need to find reasons for these differences to inform screening, surveillance, and treatment strategies for CRC and its precursors in this high-risk group.
Assuntos
Colangite , Colite Ulcerativa , Neoplasias Colorretais , Doença de Crohn , Doenças Inflamatórias Intestinais , Idoso , Humanos , Pessoa de Meia-Idade , Colite Ulcerativa/complicações , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/patologia , Neoplasias Colorretais/diagnóstico , Doença de Crohn/complicações , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/patologia , Fatores de Risco , Medicina EstatalRESUMO
BACKGROUND & AIMS: Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. METHODS: We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. RESULTS: Of the PCCRCs identified, 43% were in high-risk patients (those with inflammatory bowel disease, previous CRC, previous multiple large polyps, or hereditary cancer syndromes) and 66% were located distal to the hepatic flexure. There was no correlation between postcolonoscopy colorectal tumor size and time to diagnosis after index colonoscopy. Bowel preparation was poor in 19% of index colonoscopies, and only 36% of complete colonoscopies had adequate photodocumentation of completion. Development of 73% of PCCRCs was determined to be affected by technical endoscopic factors, 17% of PCCRCs by administrative factors (follow-up procedures delayed/not booked by administrative staff), and 27% of PCCRCs by decision-making factors. Twenty-seven percent of PCCRCs were categorized as possible missed lesion, prior examination adequate; 58% as possible missed lesion, prior examination inadequate; 8% as detected lesion, not resected; and 7% as incomplete resection of previously observed lesion; 89% were deemed to be avoidable. CONCLUSIONS: In a retrospective analysis of PCCRCs, using the WEO system of categorization, we found 43% to occur in high-risk patients; this might be reduced with more vigilant surveillance. Measures are needed to reduce technical, decision-making, and administrative factors. We found that 89% of PCCRCs may be avoidable. If half of avoidable PCCRCs could be prevented, the target rate of 2% for the PCCRC-3y (cancer diagnosed between 6 and 36 months after index colonoscopy) benchmark would be achievable.
Assuntos
Assistência ao Convalescente/normas , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio/prevenção & controle , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Adulto , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Benchmarking/estatística & dados numéricos , Tomada de Decisão Clínica , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Inglaterra/epidemiologia , Reações Falso-Negativas , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Reto/diagnóstico por imagem , Reto/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Carga TumoralRESUMO
BACKGROUND & AIMS: There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. METHODS: The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. RESULTS: A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). CONCLUSIONS: This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.
Assuntos
Tatuagem , Colo , Endoscopia , HumanosRESUMO
BACKGROUND & AIMS: Colonoscopy examination does not always detect colorectal cancer (CRC)- some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term is too restrictive, so the term post-colonoscopy colorectal cancer (PCCRC) was created in 2010. However, PCCRC definitions and methods for calculating rates vary among studies, making it impossible to compare results. We aimed to standardize the terminology, identification, analysis, and reporting of PCCRCs and CRCs detected after other whole-colon imaging evaluations (post-imaging colorectal cancers [PICRCs]). METHODS: A 20-member international team of gastroenterologists, pathologists, and epidemiologists; a radiologist; and a non-medical professional met to formulate a series of recommendations, standardize definitions and categories (to align with interval cancer terminology), develop an algorithm to determine most-plausible etiologies, and develop standardized methodology to calculate rates of PCCRC and PICRC. The team followed the Appraisal of Guidelines for Research and Evaluation II tool. A literature review provided 401 articles to support proposed statements; evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The statements were voted on anonymously by team members, using a modified Delphi approach. RESULTS: The team produced 21 statements that provide comprehensive guidance on PCCRCs and PICRCs. The statements present standardized definitions and terms, as well as methods for qualitative review, determination of etiology, calculation of PCCRC rates, and non-colonoscopic imaging of the colon. CONCLUSIONS: A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.
Assuntos
Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Guias de Prática Clínica como Assunto/normas , Colo/diagnóstico por imagem , Colonoscopia/métodos , Consenso , Detecção Precoce de Câncer/métodos , Humanos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Robust real-world performance data of newly independent colonoscopists are lacking. In the United Kingdom, provisional colonoscopy certification (PCC) marks the transition from training to newly independent practice. We aimed to assess changes in key performance indicators (KPIs) such as cecal intubation rate (CIR) in the periods pre- and post-PCC, particularly regarding rates and predictors of trainees exhibiting a drop in performance (DIP), defined as CIR <90% in the first 50 procedures post-PCC. METHODS: A prospective United Kingdom-wide observational study of Joint Advisory Group on Gastrointestinal Endoscopy Electronic Training System (JETS) e-portfolio colonoscopy entries (257,800) from trainees awarded PCC between July 2011 and 2016 was undertaken. Moving average analyses were used to study KPI trends relative to PCC. Pre-PCC trainee, trainer, and training environment factors were compared between DIP and non-DIP cohorts to identify predictors of DIP. RESULTS: Seven hundred thirty-three trainees from 180 centers were awarded PCC after a median of 265 procedures and 3.1 years. Throughout the early post-PCC period, average CIRs surpassed the national 90% standard. Despite this, not all trainees achieved this standard post-PCC, with DIP observed in 18.4%. DIP was not influenced by trainer presence and diminished after 100 additional procedures. On multivariable analysis, pre-PCC CIRs and trainer specialty were predictive of DIP. Trainees with DIP incurred higher post-PCC rates of moderate to severe discomfort despite requiring higher analgesic dosages and were more likely to require trainer assistance in failed procedures. CONCLUSIONS: The current PCC requirements are appropriate for diagnostic colonoscopy. It is possible to identify predictors of underperformance in trainees, which may be of value to training leads and could improve the patient experience.
Assuntos
Competência Clínica , Colonoscopia/normas , Indicadores de Qualidade em Assistência à Saúde , Certificação , Colonoscopia/educação , Cirurgia Colorretal/educação , Cirurgia Colorretal/normas , Gastroenterologia/educação , Gastroenterologia/normas , Medicina Geral/educação , Medicina Geral/normas , Humanos , Modelos Lineares , Modelos Logísticos , Análise Multivariada , Enfermagem/normas , Estudos Prospectivos , Reino UnidoRESUMO
This White Paper shares guidance on the important principles of training endoscopy teachers, the focus of an American Society for Gastrointestinal Endoscopy (ASGE)/World Endoscopy Organization Program for Endoscopic Teachers and Leaders of Endoscopic Training held at the ASGE Institute for Training and Technology. Key topics included the need for institutional support and continuous skills development, the importance of consensus and consistency in content and approach to teaching, the role of conscious competence and content breakdown into discreet steps in effective teaching, defining roles of supervisors versus instructors to ensure teaching consistency across instructors, identification of learning environment factors and barriers impacting effective teaching, and individualized training that incorporates effective feedback and adapts with learner proficiency. Incorporating simulators into endoscopy teaching, applying good endoscopy teaching principles outside the endoscopy room, key principles of hands-on training, and effective use of simulators and models in achieving specific learning objectives were demonstrated with rotations through hands-on simulator stations as part of the program. A discussion of competency-based assessment was followed by live sessions in which attendees applied endoscopy teaching principles covered in the program. Conclusions highlighted the need for the following: formal training of endoscopy teachers to a level of conscious competence, incorporation of formal training structures into existing training curricula, intentional teaching preparation, feedback to trainees and instructors alike aimed at improving performance, and competency-based trainee assessment. The article is intended to help motivate individuals who play a role in training other endoscopists to develop their teaching abilities, promote discussions about endoscopy training, and engage both endoscopy trainers and trainees in a highly rewarding learning process that is in the best interest of patients.
Assuntos
Competência Clínica , Endoscopia Gastrointestinal/educação , Gastroenterologia/educação , Treinamento por Simulação , Capacitação de Professores , Currículo , Feedback Formativo , Humanos , Ensino/educaçãoRESUMO
BACKGROUND: The post-colonoscopy colorectal cancer (PCCRC) rate is a key quality indicator for colonoscopy. Previously published PCCRC rates have been difficult to compare owing to differences in methodology. The primary aim of this study was to compare Danish PCCRC rates internationally and to calculate Danish PCCRC rates using the World Endoscopy Organization (WEO) consensus method for future comparison. The secondary aim was to identify factors associated with PCCRC. METHODS: National registries were used to examine the risk of PCCRC. The Danish 3-year rate of PCCRC (PCCRC-3yr) was calculated using previously published methods from England, Sweden, and the WEO. Poisson regression analysis was performed to identify factors associated with PCCRC. RESULTS: The Danish PCCRC-3yr was significantly higher than the rate in the English NHS (relative risk [RR] 1.12, 95â% confidence interval [CI] 1.05â-â1.19) and Sweden (RR 1.15, 95â%CI 1.06â-â1.24). The Danish PCCRC-3yr based on the WEO consensus method fell from 22.5â% in 2001 to 7.9â% in 2012.âThe multivariable Poisson regression model found PCCRC to be significantly associated with diverticulitis (RR 3.25, 95â%CI 2.88â-â3.66), ulcerative colitis (RR 3.44, 95â%CI 2.79â-â4.23), hereditary cancer (age <â60 years: RR 7.39, 95â%CI 5.77â-â9.47; ageâ≥â60 years: RR 3.81, 95â%CI 2.74â-â5.31), and location in the transverse (RR 1.57, 95â%CI 1.28â-â1.94) and ascending colon (RR 1.85, 95â%CI 1.64â-â2.08). CONCLUSIONS: The PCCRC-3yr was higher in Denmark than in comparable countries. Differences in colonoscopist training, background, and certification are possible contributing factors. A review of colonoscopist training and certification in Denmark, and continuous audit and feedback of colonoscopist performance may reduce PCCRC-3yr.
Assuntos
Colonoscopia , Neoplasias Colorretais/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Risco , Medicina Estatal , Suécia/epidemiologiaRESUMO
The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.âe. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures for both small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, where performance measures had already been identified, this is the first time that small-bowel endoscopy quality measures have been proposed.
RESUMO
Objective: Cecal intubation rate (CIR) is known to be inversely associated with interval colorectal cancer (CRC) risk. Cecal intubation may be achieved by the use of force and sedation jeopardizing patient safety. The Performance Indicator of Colonic Intubation (PICI) is defined as the proportion of colonoscopies achieving cecal intubation with use of ≤2 mg midazolam and no-mild patient-experienced discomfort. We aimed (i) to measure the variation of PICI between colonoscopists and colonoscopy units; (ii) to assess the correlation between the individual components of PICI; and (iii) to evaluate the association between PICI and commonly used performance indicators. Materials and methods: For the period 1 July 2015 through 30 June 2017 of the prevalent round of the Danish FIT-based CRC screening program, we included colonoscopies performed at four units in the Central Denmark Region within 60 days after a positive FIT-test. The PICI variation was evaluated using rates and ranges. Correlations between individual PICI components were assessed using Pearson correlation coefficients. Polyp detection rate (PDR), Adenoma detection rate (ADR), Polyp retrieval rate (PRR) and Withdrawal time (WT) were assessed within PICI quartiles. Results: The overall PICI was 78.7% with substantial variation between colonoscopists (40.0-91.9%) and units (72.6-82.0%). CIR was significantly correlated with patient-experienced comfort (r = 0.49, n = 73, p < .0001) and we observed that colonoscopists with a PICI between 79.9% and 84.3%) had the highest ADR. Conclusion: We found a substantial variation in PICI between colonoscopists and between colonoscopy units, which may reflect potential for quality improvements.
Assuntos
Colonoscopia/estatística & dados numéricos , Colonoscopia/normas , Detecção Precoce de Câncer/métodos , Indicadores de Qualidade em Assistência à Saúde , Adenoma/diagnóstico por imagem , Fatores Etários , Idoso , Ceco , Competência Clínica , Pólipos do Colo/diagnóstico por imagem , Colonoscopia/efeitos adversos , Neoplasias Colorretais/diagnóstico por imagem , Dinamarca , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Gastrointestinal , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Sangue Oculto , Dor Processual/etiologia , Melhoria de Qualidade , Fatores SexuaisRESUMO
Objective: From the prevalent round of the Danish FIT-based colorectal cancer (CRC) screening program, we aimed (i) to evaluate the quality of recorded data and (ii) to characterize the colonoscopies by measuring variation in performance indicators between colonoscopists and assessing the ratio between adenoma detection rate (ADR) and polyp detection rate (PDR). Materials and methods: This study included screening colonoscopies performed in Central Denmark Region within 60 days of a positive FIT-result from 1 July 2015 through 30 June 2017. The participants were the colonoscopists, performing these procedures. The quality indicators cecal intubation rate (CIR), PDR, polyp retrieval rate (PRR), ADR and withdrawal time (WT) were evaluated. ADR/PDR ratios were calculated. Results: The concordance between the recorded data and the colonoscopy reports showed Kappa values in the range of 0.47-0.97. The overall CIR was 90.6% (range 73.7%-100%), PDR: 51.9% (range 18.4%-70.2%), PRR: 94.6% (range 69.6%-100%), ADR (conventional adenomas): 50.6% (range 18.4%-70.2%), ADRx (conventional adenomas, traditional serrated adenomas and sessile serrated lesions with dysplasia): 50.9% (range 18.4%-70.2%) and the mean WT was 11.3 min (range 4.5-24.9 min). The ADR/PDR ratio was 92.8% (95% CI: 92.0%-93.6%) and the ADRx/PDR ratio was 93.2% (95% CI: 92.4%-93.9%). Conclusion: Data quality was generally high. We found considerable variation in performance indicators between colonoscopists reflecting the potential for improvement. Further, our findings revealed that the PDR might be a good proxy for ADR in the context of the prevalent round of FIT-based CRC screening programs.
Assuntos
Adenoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Idoso , Confiabilidade dos Dados , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à SaúdeRESUMO
BACKGROUND AND STUDY AIM: Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. METHODS : Data from 20â 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2âmg) of midazolam or less, and nurse-assessed comfort score of 1â-â3/5.âMultivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. RESULTS : PICI was achieved in 54.1â% of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIRâ+âcomfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years' experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. CONCLUSIONS : PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives.
Assuntos
Colonoscopia/normas , Indicadores de Qualidade em Assistência à Saúde , Fatores Etários , Idoso , Ceco , Competência Clínica , Pólipos do Colo/diagnóstico por imagem , Colonoscopia/efeitos adversos , Colonoscopia/educação , Colonoscopia/estatística & dados numéricos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Gastrointestinal , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Sangue Oculto , Dor Processual/etiologia , Melhoria de Qualidade , Fatores SexuaisRESUMO
BACKGROUND: Direct Observation of Procedural Skills (DOPS) is an established competence assessment tool in endoscopy. In July 2016, the DOPS scoring format changed from a performance-based scale to a supervision-based scale. We aimed to evaluate the impact of changes to the DOPS scale format on the distribution of scores in novice trainees and on competence assessment. METHODS: We performed a prospective, multicenter (nâ=â276), observational study of formative DOPS assessments in endoscopy trainees with ≤â100 lifetime procedures. DOPS were submitted in the 6-months before July 2016 (old scale) and after (new scale) for gastroscopy (nâ=â2998), sigmoidoscopy (nâ=â1310), colonoscopy (nâ=â3280), and polypectomy (nâ=â631). Scores for old and new DOPS were aligned to a 4-point scale and compared. RESULTS: 8219 DOPS (43â% new and 57â% old) submitted for 1300 trainees were analyzed. Compared with old DOPS, the use of the new DOPS was associated with greater utilization of the lowest score (2.4â% vs. 0.9â%; Pâ<â0.001), broader range of scores, and a reduction in competent scores (60.8â% vs. 86.9â%; Pâ<â0.001). The reduction in competent scores was evident on subgroup analysis across all procedure types (Pâ<â0.001) and for each quartile of endoscopy experience. The new DOPS was superior in characterizing the endoscopy learning curve by demonstrating progression of competent scores across quartiles of procedural experience. CONCLUSIONS: Endoscopy assessors applied a greater range of scores using the new DOPS scale based on degree of supervision in two cohorts of trainees matched for experience. Our study provides construct validity evidence in support of the new scale format.
Assuntos
Competência Clínica/normas , Pólipos do Colo/cirurgia , Gastroscopia/normas , Observação , Sigmoidoscopia/normas , Avaliação Educacional/métodos , Gastroscopia/educação , Humanos , Estudos Prospectivos , Sigmoidoscopia/educaçãoRESUMO
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at center and endoscopist level: 1: Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90â%); 2: Antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95â%); 3: Bile duct cannulation rate (key performance measure, at least 90â%); 4: Tissue sampling during EUS (key performance measure, at least 85â%); 5: Appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95â%); 6: Bile duct stone extraction (key performance measure, at least 90â%); 7: Post-ERCP pancreatitis (key performance measure, less than 10â%). 8: Adequate documentation of EUS landmarks (minor performance measure, at least 90â%).This present list of quality performance measures for ERCP and EUS recommended by ESGE should not be considered to be exhaustive: it might be extended in future to address further clinical and scientific issues.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/normas , Endossonografia/normas , Indicadores de Qualidade em Assistência à Saúde , Antibioticoprofilaxia/normas , Biópsia/normas , Cateterismo/normas , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco , Cálculos Biliares/terapia , Humanos , Pancreatite/etiologia , Melhoria de Qualidade , Stents/normasRESUMO
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.
Assuntos
Endoscopia Gastrointestinal/normas , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Segurança/normas , Endoscopia Gastrointestinal/efeitos adversos , Equipamentos e Provisões/normas , Instalações de Saúde/normas , Humanos , Consentimento Livre e Esclarecido/normas , Liderança , Conforto do Paciente/normas , Educação de Pacientes como Assunto/normas , Participação do Paciente , Seleção de Pacientes , Privacidade , Encaminhamento e Consulta/normas , Recursos Humanos/normasRESUMO
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 Rate of adequate bowel preparation (minimum standard 90â%); 2 Cecal intubation rate (minimum standard 90â%); 3 Adenoma detection rate (minimum standard 25â%); 4 Appropriate polypectomy technique (minimum standard 80â%); 5 Complication rate (minimum standard not set); 6 Patient experience (minimum standard not set); 7 Appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.
Assuntos
Adenoma/diagnóstico por imagem , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico por imagem , Intubação/normas , Vigilância da População , Agendamento de Consultas , Catárticos/uso terapêutico , Ceco , Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Humanos , Satisfação do Paciente , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Fatores de TempoRESUMO
OBJECTIVE: Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial. DESIGN: 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤ 25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders' ADR. Mixed effect models using ORs and 95% CIs were computed. RESULTS: The study included 24,582 colonoscopies performed by 38 leaders and 56,617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017). CONCLUSIONS: Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy. TRIAL REGISTRATION NUMBER: NCT01667198.
Assuntos
Adenoma/diagnóstico , Colonoscopia/educação , Neoplasias Colorretais/diagnóstico , Liderança , Programas de Rastreamento , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Polônia , Melhoria de Qualidade , Método Simples-CegoRESUMO
To develop standards for high quality in gastrointestinal (GI) endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all GI endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on the requirements for high-quality endoscopy reporting systems in GI endoscopy. Recommendations 1 Endoscopy reporting systems must be electronic. 2 Endoscopy reporting systems should be integrated into hospitals' patient record systems. 3 Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4 Endoscopy reporting systems shall restrict the use of free-text entry to a minimum, and be based mainly on structured data entry. 5 Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6 Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7 Endoscopy reporting systems shall facilitate the inclusion of information on histopathology of detected lesions, patient satisfaction, adverse events, and surveillance recommendations. 8 Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format. 9 Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees. 10 Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.