title: Time trends in quality indicators of colonoscopy.
abstract: BACKGROUND
  There is considerable variation in the quality of colonoscopy performance. The Norwegian quality assurance programme Gastronet registers outpatient colonoscopies performed in Norwegian endoscopy centres. The aim of Gastronet is long-term improvement of endoscopist and centre performance by annual feedback of performance data.
  
  
  OBJECTIVE
  The objective of this article is to perform an analysis of trends of quality indicators for colonoscopy in Gastronet.
  
  
  METHODS
  This prospective cohort study included 73,522 outpatient colonoscopies from 73 endoscopists at 25 endoscopy centres from 2003 to 2012. We used multivariate logistic regression with adjustment for relevant variables to determine annual trends of three performance indicators: caecum intubation rate, pain during the procedure, and detection rate of polyps ≥5 mm.
  
  
  RESULTS
  The proportion of severely painful colonoscopies decreased from 14.8% to 9.2% (relative risk reduction of 38%; OR = 0.92 per year in Gastronet; 95% CI 0.86-1.00; p = 0.045). Caecal intubation (OR = 0.99; 95% CI 0.94-1.04; p = 0.6) and polyp detection (OR = 1.03; 95% CI 0.99-1.07; p = 0.15) remained unchanged during the study period.
  
  
  CONCLUSIONS
  Pain at colonoscopy showed a significant decrease during years of Gastronet participation while caecal intubation and polyp detection remained unchanged - independent of the use of sedation and/or analgesics and level of endoscopist experience. This may be due to the Gastronet audit, but effects of improved endoscopy technology cannot be excluded.
authors.affiliation: Department of Medicine, Telemark Hospital, Skien, Norway.
authors.forename: Volker
authors.initials: V
authors.lastname: Moritz
authors.affiliation: Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
authors.forename: Michael
authors.initials: M
authors.lastname: Bretthauer
authors.affiliation: Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Holme
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Wang Fagerland
authors.affiliation: Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Departments of Epidemiology and Biostatistics; Harvard School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA; Cancer Registry of Norway, Oslo, Norway.
authors.forename: Magnus
authors.initials: M
authors.lastname: Løberg
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Glomsaker
authors.affiliation: Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: de Lange
authors.affiliation: Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Seip
authors.affiliation: Department of Medicine, Østfold Hospital, Frederikstad, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Sandvei
authors.affiliation: Department of Medicine, Telemark Hospital, Skien, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; Cancer Registry of Norway, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Hoff
keywords: Abdominal pain; caecum intubation rate; colonoscopy; polyp detection rate; quality assurance; quality indicator