TY - JOUR
T1 - Impact of a scalable training program on the quality of colonoscopy performance and risk of postcolonoscopy colorectal cancer
AU - Corley, Douglas A.
AU - Jensen, Christopher D.
AU - Lee, Jeffrey K.
AU - Levin, Theodore R.
AU - Zhao, Wei K.
AU - Schottinger, Joanne E.
AU - Ghai, Nirupa R.
AU - Doubeni, Chyke A.
AU - Halm, Ethan A.
AU - Sugg Skinner, Celette
AU - Udaltsova, Natalia
AU - Contreras, Richard
AU - Fireman, Bruce H.
AU - Quesenberry, Charles P.
N1 - Publisher Copyright:
© 2023 American Society for Gastrointestinal Endoscopy
PY - 2023/10
Y1 - 2023/10
N2 - Background and Aims: Endoscopist adenoma detection rates (ADRs) vary widely and are associated with patients’ risk of postcolonoscopy colorectal cancers (PCCRCs). However, few scalable physician-directed interventions demonstrably both improve ADR and reduce PCCRC risk. Methods: Among patients undergoing colonoscopy, we evaluated the influence of a scalable online training on individual-level ADRs and PCCRC risk. The intervention was a 30-minute, interactive, online training, developed using behavior change theory, to address factors that potentially impede detection of adenomas. Analyses included interrupted time series analyses for pretraining versus posttraining individual-physician ADR changes (adjusted for temporal trends) and Cox regression for associations between ADR changes and patients’ PCCRC risk. Results: Across 21 endoscopy centers and all 86 eligible endoscopists, ADRs increased immediately by an absolute 3.13% (95% confidence interval [CI], 1.31-4.94) in the 3-month quarter after training compared with .58% per quarter (95% CI, .40-.77) and 0.33% per quarter (95% CI, .16-.49) in the 3-year pretraining and posttraining periods, respectively. Posttraining ADR increases were higher among endoscopists with pretraining ADRs below the median. Among 146,786 posttraining colonoscopies (all indications), each 1% absolute increase in screening ADR posttraining was associated with a 4% decrease in their patients’ PCCRC risk (hazard ratio, .96; 95% CI, .93-.99). An ADR increase of ≥10% versus <1% was associated with a 55% reduced risk of PCCRC (hazard ratio, .45; 95% CI, .24-.82). Conclusions: A scalable, online behavior change training intervention focused on modifiable factors was associated with significant and sustained improvements in ADR, particularly among endoscopists with lower ADRs. These ADR changes were associated with substantial reductions in their patients’ risk of PCCRC.
AB - Background and Aims: Endoscopist adenoma detection rates (ADRs) vary widely and are associated with patients’ risk of postcolonoscopy colorectal cancers (PCCRCs). However, few scalable physician-directed interventions demonstrably both improve ADR and reduce PCCRC risk. Methods: Among patients undergoing colonoscopy, we evaluated the influence of a scalable online training on individual-level ADRs and PCCRC risk. The intervention was a 30-minute, interactive, online training, developed using behavior change theory, to address factors that potentially impede detection of adenomas. Analyses included interrupted time series analyses for pretraining versus posttraining individual-physician ADR changes (adjusted for temporal trends) and Cox regression for associations between ADR changes and patients’ PCCRC risk. Results: Across 21 endoscopy centers and all 86 eligible endoscopists, ADRs increased immediately by an absolute 3.13% (95% confidence interval [CI], 1.31-4.94) in the 3-month quarter after training compared with .58% per quarter (95% CI, .40-.77) and 0.33% per quarter (95% CI, .16-.49) in the 3-year pretraining and posttraining periods, respectively. Posttraining ADR increases were higher among endoscopists with pretraining ADRs below the median. Among 146,786 posttraining colonoscopies (all indications), each 1% absolute increase in screening ADR posttraining was associated with a 4% decrease in their patients’ PCCRC risk (hazard ratio, .96; 95% CI, .93-.99). An ADR increase of ≥10% versus <1% was associated with a 55% reduced risk of PCCRC (hazard ratio, .45; 95% CI, .24-.82). Conclusions: A scalable, online behavior change training intervention focused on modifiable factors was associated with significant and sustained improvements in ADR, particularly among endoscopists with lower ADRs. These ADR changes were associated with substantial reductions in their patients’ risk of PCCRC.
UR - http://www.scopus.com/inward/record.url?scp=85168527500&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85168527500&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2023.04.2073
DO - 10.1016/j.gie.2023.04.2073
M3 - Article
C2 - 37094690
AN - SCOPUS:85168527500
SN - 0016-5107
VL - 98
SP - 609
EP - 617
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -