title: Effect of an endoscopic quality improvement program on adenoma detection rates: a multicenter cluster-randomized controlled trial in a clinical practice setting (EQUIP-3).
abstract: BACKGROUND
  Colonoscopy is protective against colorectal cancer, but its quality and protective benefits can vary. Adenoma detection rate (ADR) is associated with quality and the degree of protection against colorectal cancer and death. In a previous, single academic center, randomized, controlled trial, we demonstrated that an endoscopic quality improvement program increased ADR (EQUIP-1) and that those increases were durable (EQUIP-2). We hypothesized that EQUIP training would increase ADR in a multicenter clinical practice setting.
  
  
  METHODS
  Nine large clinical practice sites were recruited. After a baseline period (phase I), 5 sites were randomized to receive supplemental in-person EQUIP training with active feedback. After follow-up (phase II), the changes in ADRs at these sites were compared with the changes at 4 control sites that did not receive training or feedback until after study completion.
  
  
  RESULTS
  Twenty-two thousand three hundred sixteen colonoscopies were included. There was a statistically significant increase in ADR at the training sites (odds ratio [OR], 1.28; P = .004) with a raw ADR of 31% in phase I and 42% in phase II after the intervention. However, raw ADRs also increased at the control sites (from 36% to 39%). As a result, there was limited evidence of a training effect (OR, 1.03; 95% confidence interval [CI], 0.84-1.25; P = .78).
  
  
  CONCLUSIONS
  ADRs increased at the sites participating in the endoscopic quality improvement program. However it is not clear to what extent the training program is responsible for the changes, because raw ADRs also increased at the control sites but to a lesser extent. (Clinical Trials Registration number: NCT02325635.).
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. Electronic address: Wallace.michael@mayo.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Crook
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Thomas
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Estella
authors.initials: E
authors.lastname: Staggs
authors.affiliation: American College of Gastroenterology, Bethesda, Maryland, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Parker
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003113:Colonoscopy / Q000193:education*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058996:Quality Improvement