[Development and validation of quality standards for colonoscopy].
OBJECTIVE
Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement.


METHODS
After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of chi(2).


RESULTS
Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01).


CONCLUSIONS
We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening.
Sánchez Del Río
Antonio
A
Servicio de Aparato Digestivo, Clínica Hospiten Rambla, Tenerife, España. asanchez@hospiten.es
Baudet
Juan Salvador
JS
Naranjo Rodríguez
Antonio
A
Campo Fernández de Los Ríos
Rafael
R
Salces Franco
Inmaculada
I
Aparicio Tormo
Jose Ramón
JR
Sánchez Muñoz
Diego
D
Llach
Joseph
J
Hervás Molina
Antonio
A
Parra-Blanco
Adolfo
A
Díaz Acosta
Juan Antonio
JA
D003113:Colonoscopy / Q000592:standards*; D006801:Humans; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results