Effectiveness of a continuous quality improvement program on colonoscopy practice

Imperiali, G.; Minoli, Giorgio; Meucci, G.; Spinzi, Giancarlo; Strocchi, Enrico; Terruzzi, Vittorio; Radaelli, Franco

doi:10.1055/s-2006-945196

Cited by 69 publications

(59 citation statements)

References 16 publications

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“…An important difference between our and Kahi's study is case-mix differences of non-screening and screening procedures. An explanation for Kahi's remarkably high ADR might be the combination of screening focusing on polyps, few endoscopists (only six) and few procedures (fewer than 1000) in contrast to our present study and those of Imperiali 25 and Gavin 24 comprising routine colonoscopies focusing on explanations for symptoms and with much higher numbers of procedures and endoscopists. It is, however, encouraging to see that in our sensitivity analysis, 'poor starter' endoscopists obtained a significant improvement in PDR-5 mm, increasing from 13.5% in their first year to 30.8% in the seventh year (adjusted OR 1.23, 95% CI 1.10-1.38, p < 0.001) which is comparable to Kahi's results.…”

Section: Pdrcontrasting

confidence: 87%

“…23 By Joint Advisory Group (JAG) visits to centres and accreditation of centres and endoscopists, the CIR improved to 92% in 2012. 24 Others have also succeeded using local resources discussing performance results and intervention, like Imperiali et al 25 in Northern Italy, where CIR was improved from 85% to 90%. Ball et al 26 in England achieved an impressive improvement on CIR from 60% to 94% by a combination of organisational measures which included more time per colonoscopy, letting the most successful endoscopists perform more colonoscopies, retraining the less successful and even advising some to give up colonoscopy entirely.…”

Section: Cirmentioning

confidence: 99%

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Time trends in quality indicators of colonoscopy

et al. 2016

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Background: There is considerable variation in the quality of colonoscopy performance. The Norwegian quality assurance programme Gastronet registers outpatient colonoscopies performed in Norwegian endoscopy centres. The aim of Gastronet is long-term improvement of endoscopist and centre performance by annual feedback of performance data. Objective: The objective of this article is to perform an analysis of trends of quality indicators for colonoscopy in Gastronet.Methods: This prospective cohort study included 73,522 outpatient colonoscopies from 73 endoscopists at 25 endoscopy centres from 2003 to 2012. We used multivariate logistic regression with adjustment for relevant variables to determine annual trends of three performance indicators: caecum intubation rate, pain during the procedure, and detection rate of polyps 5 mm. Results: The proportion of severely painful colonoscopies decreased from 14.8% to 9.2% (relative risk reduction of 38%; OR ¼ 0.92 per year in Gastronet; 95% CI 0.86-1.00; p ¼ 0.045). Caecal intubation (OR ¼ 0.99; 95% CI 0.94-1.04; p ¼ 0.6) and polyp detection (OR ¼ 1.03; 95% CI 0.99-1.07; p ¼ 0.15) remained unchanged during the study period. Conclusions: Pain at colonoscopy showed a significant decrease during years of Gastronet participation while caecal intubation and polyp detection remained unchanged -independent of the use of sedation and/or analgesics and level of endoscopist experience. This may be due to the Gastronet audit, but effects of improved endoscopy technology cannot be excluded.

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Section: Pdrcontrasting

confidence: 87%

Section: Cirmentioning

confidence: 99%

Time trends in quality indicators of colonoscopy

et al. 2016

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“…We chose the published guidelines (21,22) for our comparison and analysis because they were developed through a consensus and peer-review process. The effectiveness of a colonoscopy depends on the adequate visualization of the entire colon which relies on bowel cleansing and the expertise of the endoscopist in performing careful examinations in order not to miss any lesion, reach the caecum and remove all the polyps detected (11,23). Various studies suggest that some endoscopists could leave up to half of the adenomas undiagnosed (24).…”

Section: Based On Faecal Occult Blood Testmentioning

confidence: 99%

Colonoscopy quality assessment in a mass population screening programme based on faecal occult blood test

Binefa

García

Milà

et al. 2013

Rev. esp. enferm. dig.

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Background and aim: the success of colorectal cancer (CRC) screening programmes largely depends on the quality of the events, processes and outcomes and therefore, quality assurance of endoscopy is an essential component. The quality indicators for colonoscopy in a screening programme setting are different from those performed in symptomatic people. The objective of this study was to report the main quality indicators of colonoscopies performed after a positive faecal occult blood test (FOBT) in a CRC screening programme in Catalonia.Methods: the period of study includes three rounds of the CRC screening programme from June 2006 to July 2013. Two types of FOBT were used: a qualitative biochemical guaiac-based test (gFOBT) and a quantitative immunochemical test (FIT). Quality indicators analysed in this study were compared to recommended colonoscopy standards from the published guidelines.Results: during the study period, 1,806 colonoscopies were performed in 1,691 individuals with a positive FOBT. All indicators were within the standard except waiting time to colonoscopy. Caecal intubation rate was 95.6 % and adequate bowel cleansing 93.6 %. Adenoma detection rate was better using FIT than gFOBT, 30.7 and 3.8 per 1,000 screenees, respectively. Cancer detection rate was also greater using FIT. Nearly 62 % of cancers were diagnosed at an early stage. The overall complication rate was 10.7 ‰.Conclusion: although the majority of results reached the recommended standards, some areas have been identified for quality enhancement. Continuous monitoring of quality indicators is essential for improving the current effectiveness of CRC screening programmes.

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“…Patient cooperation during colonoscopy has such a considerable repercussion that his/her non-cooperation is considered an absolute contraindication for a colonoscopy (8) . Likewise, low tolerance to colonoscopy was responsible for approximately 50% of incomplete examinations (15) . Currently, the assessment of health care quality with respect to satisfaction, and exceeding the client's expectation (patient) as an important marketing tool to attract new clients has become increasingly evident.…”

Section: Introductionmentioning

confidence: 99%

What Are the Most Important Factors Regarding Acceptance to the Colonoscopy?

Ussui

Silva

Borges

et al. 2013

Arq. Gastroenterol.

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-Context -Colonoscopy plays an indubitable role in the setting of clinical practice, however, it is an invasive exam; complex, lengthy, embarrassing, not devoid of risks and discomfort that yields fear and anxiety in the majority of patients. In a new era of rising competition between health institutions, where the quality of health care and client satisfaction are praised, studies regarding tolerance-related colonoscopy issues yield great potential to be explored. In the present study, tolerance is defined as willingness to repeat the exam. Objectives -Evaluate information associated to bowel preparation, the exam itself and post-examination period that might interfere with the tolerance to the colonoscopy. Methods -Analysis of the tolerance to the colonoscopy at three stages (pre, post, and during) through a checklist: patient's questionnaire and a medical assessment form were used. Results -In this present study, 91.2% of 373 patients exhibited positive tolerance to the colonoscopy. Aspects related to a negative level of tolerance were patient gender (12.9% of women versus 3.2% of men would not repeat the exam), age extremes (less than 20 years and greater than 80 years of age), and abdominal pain, both during the bowel preparation and after the procedure. Conclusions -Gender, age, patient cooperation and abdominal pain were the decisive components regarding tolerance to the colonoscopy. Notably, in two phases of the exam, the abdominal pain was the most important feature associated to a lessened tolerance. HEADINGS -Colonoscopy. Patient satisfaction. Abdominal pain.

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Effectiveness of a continuous quality improvement program on colonoscopy practice

Abstract: The effectiveness of colonoscopy can be improved by implementing a CQI program in routine colonoscopy practice.

Cited by 69 publications

References 16 publications

Time trends in quality indicators of colonoscopy

Time trends in quality indicators of colonoscopy

Colonoscopy quality assessment in a mass population screening programme based on faecal occult blood test

What Are the Most Important Factors Regarding Acceptance to the Colonoscopy?

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