title: An explorative study from the Norwegian Quality Register Gastronet comparing self-estimated versus registered quality in colonoscopy performance.
abstract: OBJECTIVE
  The value of a colonoscopy quality assurance (QA) register may be questioned if it brings no new information on which to act for quality improvement, e. g. if self-assessed quality of colonoscopy performance correlates perfectly with registered performance.
  
  
  METHODS
  In this explorative study, 39 (33 Norwegian and 6 Swedish) out of 99 new endoscopists joining the Norwegian QA register Gastronet from 2008 to 2013 responded to an invitation to fill in a questionnaire for self-assessment of cecal intubation rate, polyp detection rate for polyps ≥ 5 mm (PDR-5 mm), withdrawal time, total examination time, and rates for severely painful and pain-free colonoscopies before receiving their first-time feedback of actually registered results from Gastronet. A linear regression analysis was applied to explore the correlation between experience level and quality of estimation.
  
  
  RESULTS
  We included 2654 colonoscopies in our study. Endoscopists underestimated their cecal intubation rate (estimated 88.8 %, registered 93.1 %, P < 0.001), total procedure time (estimated 31.7 minutes, registered 37.2 minutes, P = 0.014), withdrawal time (estimated 9.8 minutes, registered 14.4 minutes, P = 0.006) and the rate of pain-free procedures (estimated 18.3 %, registered 24.5 %, P = 0.001). Pre-study colonoscopy experience was not correlated with estimated quality for any of the indicators.
  
  
  CONCLUSIONS
  Apart from overestimation of severely painful examinations, endoscopists most often underestimated their colonoscopy performance. Self-assessed quality of colonoscopy performance may not be a satisfactory substitute for systematic registration of quality and not sufficiently valid to be acted upon.
authors.affiliation: Telemark Hospital - Department of Medicine Skien, Norway.
authors.forename: Volker
authors.initials: V
authors.lastname: Moritz
authors.affiliation: Sørlandet Hospital Kristiansand - Department of Medicine Kristiansand, Norway and University of Oslo - Institute of Health and Society, Oslo, Norway.
authors.forename: Oyvind
authors.initials: O
authors.lastname: Holme
authors.affiliation: Oslo University Hospital - Oslo Centre for Biostatistics and Epidemiology, Research Support Services Oslo, Norway.
authors.forename: Marissa
authors.initials: M
authors.lastname: Leblanc
authors.affiliation: Institute of Population-based Cancer Research - Clinical and registry-based research, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Hoff