Randomized Study of Train the Colonoscopy Leaders Course Versus Audit and Feedback on Colonoscopy Quality Indicators

Study Overview
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Brief Summary
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Professional societies recommend that endoscopists measure their ceacal intubation rate, adenoma detection rate as indicators of the screening colonoscopy quality. However, it is uncertain how to improve adenoma detection rate and reduce inter-endoscopists' variability in the detection of adenomas. The investigators hypothesize that a hands-on-training intervention tailored to the results of environmental assessment and audit on colonoscopy quality indicators results in higher adenoma detection rate improvement than simple audit and feedback. The investigators further hypothesize that by training the leaders of the screening centres, the effect of the intervention will be further disseminated among other endoscopists from the participating centers, and will thus result in additional increase in individual adenoma detection rate. The primary aim is to compare the impact on adenoma detection rate of two screening colonoscopy improvement programs: Tailored training intervention. Audit feedback on colonoscopy quality indicators.

Official Title
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Quality Improvement in Screening Colonoscopy - a Randomized Trial of Tailored Training Intervention Versus Simple Feedback on the Quality Indicators.

Conditions
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Colorectal Cancer

Intervention / Treatment
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* Procedure: Train the leaders course
* Behavioral: Audit and feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: screening center leading colonoscopist at least 30 screening colonoscopies in the 2011 edition of the screening program adenoma detection rate lower than 25% Exclusion Criteria: lack of participation in the 2012 edition of the screening program
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Train the leaders course<br> | Procedure: Train the leaders course<br>* Screening centre leaders randomized to the training intervention group will be invited to take part in a train-the-leaders course. The Train-the-leaders course will consist of three phases: (i) pre-training assessment, (ii) hands-on-training and (iii) post-training evaluation and feedback. The Train-the-leaders course will be run in polish by the team from the Maria Sklodowska-Curie Memorial Cancer Center and Institute on Oncology, Warsaw, which was trained in delivering such intervention by experts from the United Kingdom.<br>|
| Active Comparator: Audit and feedback<br> | Behavioral: Audit and feedback<br>* Screening centre leaders randomized to the feedback group will receive (by e-mail and conventional mail) feedback on their individual screening colonoscopy quality indicators (adenoma detection rate and ceacal intubation rate) measured for the 2011 edition of the national screening program. The results will be presented in a league table in order to enable comparison with anonymous results of all endoscopists who performed at least 30 colonoscopies within the screening program. In addition, a link to a webpage containing data on individual and overall colonoscopy quality indicators over the last four years of the screening program will be provided.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Screening centre leader's adenoma detection rate | Adenoma detection rate is defined as the proportion of screened subjects in whom at least one adenomatous lesion is identified. | till the end of calendar year after the training intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Screening center's overall adenoma detection rate | Adenoma detection rate is defined as the proportion of screened subjects in whom at least one adenomatous lesion is identified. | Till the end of calendar year after the training intervention | 
| Screening centre leader's proximal and distal adenoma detection rate | Adenoma detection rate is defined as the proportion of screened subjects in whom at least one adenomatous lesion is identified. | Till the end of calendar year after the training intervention | 
| Screening centre's non-polypoid lesion detection rate |  | Till the end of calendar year after the training intervention | 
| Overall screening centre's ceacal intubation rate | Ceacal intubation is defined as the passage of the colonoscope tip to a point proximal to the ileoceacal valve and visualization of the entire ceacum. | Till the end of calendar year after the training intervention | 
| Screening centre leader's withdrawal technique | Withdrawal technique assessed by a trained endoscopy nurse | Till the end of calendar year after the training intervention |