title: Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II.
abstract: OBJECTIVE
  We recently completed a randomized controlled trial of an endoscopic quality improvement program (EQUIP) that demonstrated an improved adenoma detection rate (ADR) through simple educational interventions. The aim of this study (phase III) is to examine whether the improvement in ADR in the trained endoscopists remained stable with further follow-up.
  
  
  METHODS
  We prospectively followed up 15 staff endoscopists who had previously been randomized to a quality improvement intervention. In the current study, we examined an additional 1,200 colonoscopy procedures conducted over a 5-month time period following the original study, referred to as phase III. During this time, all physicians received quarterly ADR and other quality metric feedback, and the previous control group was offered the educational intervention voluntarily. ADRs and adenoma per patient (APP) rates were estimated in the endoscopists who were and were not randomized to EQUIP training and compared with those obtained in phases I and II of the original study. The study was conducted in a tertiary care Academic Medical Center. The study sample comprised 1200 patients undergoing routine colonoscopy. The main outcome measurement was adenoma detection rate.
  
  
  RESULTS
  The previously observed increase in ADR in the trained group from 36% in phase I to 47% in phase II was maintained into phase III (46%). The ADR of the untrained group remained unchanged from phase I (36%) to phase II (35%); it was increased only marginally in phase III to 39%, which was still lower than the 46% ADR in the trained group. The trained group had an increase in APP, from 0.72 in Phase I to 0.87 in Phase II and 0.98 in Phase III. For the previously untrained group, there was no change in APP from phase I (0.68) to phase II (0.68), but there was possibly a small increase (to 0.74) in Phase III.
  
  
  CONCLUSIONS
  This study provides evidence that improvements in ADR obtained through the endoscopic quality-training program can persist for at least 5 months after completion of the program. It further suggests that a focus on ADR does not lead to a "one and done" phenomenon. The limitations of this study were as follows: single-center setting, and lack of sessile polyp information/standardization.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Ussui
authors.affiliation: 1] Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA [2] Atlanta Gastroenterology Associates, Snellville, Georgia, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Coe
authors.affiliation: 1] Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA [2] Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rizk
authors.affiliation: Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Crook
authors.affiliation: Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Diehl
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D003113:Colonoscopy / Q000193:education* / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care