Improving colonoscopy quality in the national VA healthcare system

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Contemporary clinical trials Pub Date : 2025-02-01 DOI:10.1016/j.cct.2024.107784

Andrew J. Gawron , Travis Bailey , Rachel Codden , Jason Dominitz , Samir Gupta , Christian Helfrich , Charles Kahi , Lila Krop , Carmel Malvar , Grace McKee , Morgan Millar , Ashley Mog , Tiffany Nguyen-Vu , Olga Patterson , Angela P. Presson , Sameer Saini , Mary Whooley , Yiwen Yao , Susan Zickmund , Tonya Kaltenbach

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引用次数: 0

Abstract

Background

Colorectal cancer (CRC) prevention is a Veterans Affairs (VA) priority. Colonoscopy quality, especially adenoma detection rate (ADR), is critical for effective screening. Our research indicates considerable variation in ADR among VA providers. Even a slight increase in ADR can reduce fatal CRC rates, and audit and feedback strategies have improved ADR in other settings. A recent report identified deficiencies in VA colonoscopy quality, highlighting the need for standardized documentation and reporting. To address this, we developed the VA Endoscopy Quality Improvement Program (VA-EQuIP), which aims to improve colonoscopy quality through benchmarking and collaborative learning, aligning with VA's modernization priorities and HSR&D and QUERI goals of accelerating evidence-based implementation.

Methods

We will conduct a stepped wedge cluster randomized trial to evaluate whether VA-EQuIP improves provider ADR compared to usual care, the implementation of VA-EQuIP, site-level factors associated with colonoscopy quality improvement, and components of provider behavior change. Using mixed methods our study will measure outcomes like reach, implementation, adoption, maintenance of VA-EQuIP, and provider behavior change. The analysis will include primary and secondary outcomes, such as overall and screening ADR, cecal intubation rate, and bowel preparation quality, using mixed effects generalized linear models and interrupted time-series analyses. Adoption and implementation will be evaluated through usage statistics, surveys, and qualitative interviews to identify factors influencing success.

Discussion

This study will assess the impact of VA-EQuIP on colonoscopy quality metrics and factors associated with effective implementation. VA-EQuIP infrastructure allows for national-scale implementation and evaluation of quality reporting with minimal manual labor, guiding future quality improvement efforts to ensure optimal patient care.

查看原文本刊更多论文

提高国家退伍军人医疗系统的结肠镜检查质量。

背景：结直肠癌（CRC）预防是退伍军人事务（VA）的优先事项。结肠镜检查质量，特别是腺瘤检出率（ADR）是有效筛查的关键。我们的研究表明，VA供应商之间的ADR存在相当大的差异。即使ADR的轻微增加也能降低CRC的致命性，审计和反馈策略也改善了其他环境下的ADR。最近的一份报告指出了VA结肠镜检查质量的不足，强调了标准化文件和报告的必要性。为了解决这个问题，我们制定了VA内窥镜质量改进计划（VA- equip），旨在通过基准和协作学习来提高结肠镜检查质量，与VA现代化优先事项和HSR&D和QUERI加速循证实施的目标保持一致。方法：我们将进行一项楔形分段随机试验，以评估VA-EQuIP与常规护理相比是否改善了提供者不良反应，VA-EQuIP的实施，与结肠镜检查质量改善相关的现场水平因素，以及提供者行为改变的组成部分。使用混合方法，我们的研究将衡量VA-EQuIP的覆盖范围、实施、采用、维护和提供者行为改变等结果。分析将包括主要和次要结果，如总体和筛选不良反应、盲肠插管率和肠准备质量，使用混合效应广义线性模型和中断时间序列分析。采用和实施将通过使用统计、调查和定性访谈来评估，以确定影响成功的因素。讨论：本研究将评估VA-EQuIP对结肠镜检查质量指标的影响以及与有效实施相关的因素。VA-EQuIP基础设施允许以最少的体力劳动在全国范围内实施和评估质量报告，指导未来的质量改进工作，以确保最佳的患者护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contemporary clinical trials 医学-药学

CiteScore

3.70

自引率

4.50%

发文量

281

审稿时长

44 days

期刊介绍： Contemporary Clinical Trials is an international peer reviewed journal that publishes manuscripts pertaining to all aspects of clinical trials, including, but not limited to, design, conduct, analysis, regulation and ethics. Manuscripts submitted should appeal to a readership drawn from disciplines including medicine, biostatistics, epidemiology, computer science, management science, behavioural science, pharmaceutical science, and bioethics. Full-length papers and short communications not exceeding 1,500 words, as well as systemic reviews of clinical trials and methodologies will be published. Perspectives/commentaries on current issues and the impact of clinical trials on the practice of medicine and health policy are also welcome.