Effect of an educational intervention on colonoscopy quality outcomes

Abstract

Background: We aimed to assess the effect of a colonoscopy skills improvement (CSI) course on quality indicators at our institution.

Methods: This retrospective cohort study included ten surgeons and nine gastroenterologists practicing in a tertiary referral center who had undergone CSI training between 2014 and 2015. Procedural data for 50 colonoscopies by each physician was collected immediately before and after CSI training, and again 8 months after training. The primary outcome was adenoma detection rate (ADR) and secondary outcomes included colonoscopy completion rate (CCR), and withdrawal time (WT). Univariate analysis followed by stepwise multivariable logistic regression was performed to assess for predictors of these outcomes. These variables included patient age, gender, indication for colonoscopy, quality of bowel preparation, and CSI training.

Results: 2533 colonoscopies were included. There was no improvement in ADR for the entire group immediately after training and at 8 months (31.8% vs. 33.6% vs. 35.3%, p = 0.319). In subgroup analysis, the ADR of surgeons improved non-significantly immediately after completing the course and increased further at 8 months (30.9% vs. 31.6% vs. 37.6%, p = 0.065). The same changes were not observed for the gastroenterology subgroup (32.9% vs. 36.0% vs. 32.8%, p = 0.550). No change was noted in CCR or WT. In multivariate analysis of the surgical subgroup, increased patient age, male gender, and the 8-month time point following CSI training were associated with higher ADR.

Conclusion: CSI training is associated with an improvement in ADR for surgeons at our institution.

Keywords: Adenoma detection rate; Colonoscopy; Quality improvement.