Sustaining the vitality of colonoscopy quality improvement programmes over time. Experience from the Norwegian Gastronet programme.
OBJECTIVE
An important challenge of any quality assurance (QA) programme is to maintain interest among participants to ensure high data quality over time. The primary aim of this study was to identify factors associated with endoscopist compliance with the Norwegian QA programme for colonoscopies (Gastronet).


METHODS
The Gastronet registration tools are an endoscopy report form to be filled in directly after the procedure by the endoscopist, and a satisfaction questionnaire to be filled in by the patient on the day after the examination. During the study period from 1 January 2004 to 31 December 2006, endoscopist compliance was measured by assessing patient report coverage, defined as the percentage of patient satisfaction questionnaires received by the Gastronet secretariat divided by the total number of colonoscopy reports registered by the individual endoscopists during the study period. Multivariate logistic regression models were applied to identify individual factors related to patient report coverage.


RESULTS
Eighty-eight endoscopists from 10 hospitals contributed a total of 16,149 colonoscopies. Overall patient report coverage decreased from 87% in 2004 to 80% in 2006. A low patient report coverage was associated with time since the registrations started [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.97-0.98; P < 0.001], use of sedation (OR 0.7, 95% CI 0.61-0.76; P < 0.001), and incomplete colonoscopy (OR 0.6, 95% CI 0.54-0.76; P < 0.001).


CONCLUSIONS
Decreasing compliance with registration over time may compromise data quality and the validity of the results. Lower coverage of patient's reports (presumably for the most difficult examinations) may lead to erroneous conclusions regarding colonoscopy performance.
Seip
Birgitte
B
Department of Medicine, Telemark Hospital, Skien, Norway. bseip@online.no
Bretthauer
Michael
M
Dahler
Stein
S
Friestad
Joachim
J
Huppertz-Hauss
Gert
G
Høie
Ole
O
Kittang
Eirik
E
Nyhus
Sverre
S
Pallenschat
Jens
J
Sandvei
Per
P
Stallemo
Asbjørn
A
Svendsen
Martin Veel
MV
Hoff
Geir
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care