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Gut. 2016 Apr;65(4):616-24. doi: 10.1136/gutjnl-2014-307503. Epub 2015 Feb 10.

Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial.

Author information

1
Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
2
Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
3
Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK.
4
Department of Health Economy and Health Management, University of Oslo, Oslo, Norway Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
5
Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK.
6
Departments of Gastroenterology and Hepatology, and Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.

Abstract

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.

KEYWORDS:

ADENOMA; CLINICAL TRIALS; COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER SCREENING

PMID:
25670810
PMCID:
PMC4819605
DOI:
10.1136/gutjnl-2014-307503
[Indexed for MEDLINE]
Free PMC Article

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