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QUALITY INDICATORS FOR COLONOSCOPY IN CANADA: THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY (CAG) ENDOSCOPY QUALITY INITIATIVE (EQI) PRACTICE AUDIT PROJECT
D Armstrong1, R Hollingworth2, D MacIntosh3, J Cabrera4, Y Chen1, S Daniels5, S Gittens6, R Bridges4, P Sinclair5, C Dube4
1Division of Gastroenterology, McMaster University, Hamilton; 2Division of Gastroenterology, The Credit Valley Hospital, Mississauga, Ontario; 3Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia; 4Division of Gastroenterology, University of Calgary, Calgary, Alberta; 5Canadian Association of Gastroenterology, Oakville, Ontario; 6ECD Solutions, Atlanta, Georga, USA
Background: There is increasing pressure to document endoscopy quality indicators due to colon cancer screening programs, more stringent credentialing processes and practice audit (PA). CAG has developed credentialing guidelines (Can J Gastro 2008;22:17) and PA methods (Can J Gastro 2006;20:405) to support monitoring of colonoscopy quality indicators in clinical practice.
Aims: To facilitate colonoscopists’ (MD) PA using a novel, point-of-care data collection method.
Methods: MDs at 13 Canadian centres undertook the EQI colonoscopy PA; data were collected during procedures over periods of at least 2 weeks using data collection software (ReForm XT, Goanyware Software, Tulsa, OK) on a smartphone (Treo 650, Palm Inc, Mississauga, ON) to permit real-time data collection and prompt download to a secure website; data were then presented on a secure, password-protected website (ECD Solutions, Atlanta, GA) for inspection by MDs, consistent with PA requirements. The reasons for colonoscopy were classified as ‘Investigation of abnormality’ (INV), ‘Screening’ (SCR) and ‘Surveillance’ (SUR).
Results: Since February 2008, 45 MDs (34 GIs and 11 surgeons) have reported on 822 colonoscopies. Mean cecal intubation rates (%/MD) were: Overall: 93.9, INV: 92.1, SCR: 93.7 and SUR: 97.2. Mean polyp detection rates (%/MD) were: Median (95% CI), Overall: 33.3 (29.4-40.0), INV: 32.3 (21.4-37.5), SCR: 35.2 (20.0-50.0), SUR: 40.0 (33.3-60.0).
Conclusions: Cecal intubation rates exceed 90% and polyp detection rates exceed 30%. However, in 47.7% of procedures, mean withdrawal times are shorter than recommended (6 mins) despite marked variations related to the reason for colonoscopy and MD experience.
Real-time practice audit, with prompt, confidential, web-based presentation of each individual’s data, provides feedback necessary for improving their colonoscopy practice.