title: Utility of EFC quality indicators for colposcopy in daily practice: results from an independent, prospective multicenter trial.
abstract: OBJECTIVE
  The accuracy of colposcopy as the gold standard to manage abnormal screening tests depends on qualification and well defined standards. A recent survey of the European Federation for Colposcopy (EFC) found strong heterogeneity in the practice of colposcopy across Europe. EFC defined four quality indicators (QIs) to enable quality assessment in colposcopy as one tool to harmonize colposcopy standards. We undertook a pilot project to estimate the utility of these QIs for an independent external quality assessment in daily routine colposcopy.
  
  
  METHODS
  Participating colposcopy clinics used newly developed software for data collection. Data were automatically anonymized, encrypted and stored in a secure relational database located within the clinics' network and allowed for an independent external benchmarking comparing the performance of participating clinics according to EFC QIs.
  
  
  RESULTS
  10,869 patients referred for routine colposcopy were included. On average none of the four EFC QIs was fulfilled. One target was almost met with 83.3% instead of 85% excisional treatments/conizations containing CIN2+ and for another QI the difference of 94.4% instead of 100% cases having a colposcopic examination prior to treatment for abnormal cervical cytology was mainly explained by wrong documentation. For a third QI, visibility of the squamocolumnar junction (SCJ) was only reported in 90.9% instead of 100% but reporting improved to 94.7% after a consensus meeting. The last QI, >80% clear margins in excised lesions/conizations were not considered as useful by some clinics and therefore not documented.
  
  
  CONCLUSIONS
  At least 3 out of 4 QIs seemed to be useful for quality assessment in colposcopy but will need rewording and readjustment. All tools for an independent electronic quality assessment with the use of EFC-QI are available and could be used to achieve a high quality standard in colposcopy across Europe.
authors.affiliation: Klinikum Wolfsburg, Department of Obstetrics and Gynecology, Sauerbruchstr. 7, Wolfsburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Luyten
authors.affiliation: Partnerschaftsgesellschaft abts + partner, Prüner Gang 7, Kiel, Germany.
authors.forename: Ingke
authors.initials: I
authors.lastname: Hagemann
authors.affiliation: Gynäkologische Gemeinschaftspraxis, Karrenführerstraße 1-3, Braunschweig, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Scherbring
authors.affiliation: Institute for Cytology and Cytology (IZD), Theaterstr. 14, Hannover, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Boehmer
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Gynecology, Martinistraße 52, Hamburg, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Gieseking
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Gynecology, Martinistraße 52, Hamburg, Germany.
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
authors.affiliation: Frauenarztpraxis, Am Herzogenkamp 3, Bremen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Glasenapp
authors.affiliation: University Düsseldorf, Clinic for Gynecology and Obstetrics, Moorenstr. 5, Düsseldorf, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Hampl
authors.affiliation: Frauenarztpraxis, Heussweg 37, Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Kuehler-Obbarius
authors.affiliation: Asthenis GmbH, Aschheim, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: van den Bergh
authors.affiliation: Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Leeson
authors.affiliation: Department of Gynaecological Oncology, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Redman
authors.affiliation: Klinikum Wolfsburg, Department of Obstetrics and Gynecology, Sauerbruchstr. 7, Wolfsburg, Germany. Electronic address: k.u.petry@klinikum.wolfsburg.de.
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Petry
mesh_terms: D000328:Adult; D019985:Benchmarking; D002584:Cervix Uteri / Q000601:surgery*; D003127:Colposcopy / Q000009:adverse effects / Q000592:standards*; D005060:Europe; D005260:Female; D006801:Humans; D008877:Middle East; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012955:Societies, Medical; D009626:Terminology as Topic; D002577:Uterine Cervical Diseases / Q000175:diagnosis* / Q000601:surgery
keywords: Colposcopy; European; Quality assessment; Quality standards