title: Quality of colonoscopy in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy).
abstract: OBJECTIVE
  To assess variation in the main colonoscopy quality indicators in organised colorectal cancer (CRC) screening programmes based on faecal immunochemical test (FIT).
  
  
  METHODS
  Data from a case-series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected. The adenoma detection rate (ADR) and caecal intubation rate (CIR) were assessed for the whole population and the individual endoscopists. To explore variation in the quality indicators, multilevel analyses were performed according to patient/centre/endoscopist characteristics.
  
  
  RESULTS
  We analysed 75 569 (mean age: 61.3 years; men: 57%) colonoscopies for positive FIT performed by 479 endoscopists in 79 centres. ADR ranged from 13.5% to 75% among endoscopists (mean: 44.8%). ADR was associated with gastroenterology specialty (OR: 0.87 for others, 95% CI 0.76 to 0.96) and, at the endoscopy centre level, with the routine use of sedation (OR: 0.80 if occasional (<33%); 95% CI 0.64 to 1.00) and availability of screening-dedicated sessions (OR: 1.35; 95% CI 1.11 to 1.66). CIR ranged between 58.8% and 100% (mean: 93.1%). Independent predictors of CIR at the endoscopist level were the yearly number of screening colonoscopies performed (OR: 1.51 for endoscopists with >600 colonoscopies; 95% CI 1.11 to 2.04) and, at the endoscopy centre level, screening-dedicated sessions (OR: 2.18; 95% CI 1.24 to 3.83) and higher rates of sedation (OR: 0.47 if occasional; 95% CI 0.24 to 0.92).
  
  
  CONCLUSIONS
  The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes.
authors.affiliation: Registro Tumori del Veneto, Padova, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: CPO Piemonte and San Giovanni Battista University Hospital, Turin, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Senore
authors.affiliation: Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venice, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Da Re
authors.affiliation: Regione Lazio, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Barca
authors.affiliation: SS Prevenzione Secondaria e Screening, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Luigina Ada
authors.initials: LA
authors.lastname: Bonelli
authors.affiliation: Department of Oncological Gastroenterology, National Cancer Institute, IRCCS, Centro di Riferimento Oncologico, Aviano, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Cannizzaro
authors.affiliation: U.O. multizonale di Gastroenterologia, Ospedale S. Chiara, Trento, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Fasoli
authors.affiliation: Agenzia Regionale Sanitaria, Regione Marche, Ancona, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Furia
authors.affiliation: Endoscopia Digestiva, Università di Roma "Sapienza", Azienda Ospedaliera Sant'Andrea, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
authors.affiliation: Department of Clinical Epidemiology, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mantellini
authors.affiliation: Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Naldoni
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Romano
authors.initials: R
authors.lastname: Sassatelli
authors.affiliation: Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Rex
authors.affiliation: Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: SS Valutazione Screening, Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000379:methods* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D016001:Confidence Intervals; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D012737:Sex Factors; D013647:Task Performance and Analysis; D017749:Total Quality Management
keywords: COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER SCREENING