领导力培训以提高结肠镜筛查中腺瘤检出率：一项随机试验。
Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial.
作者信息
Kaminski Michal F, Anderson John, Valori Roland, Kraszewska Ewa, Rupinski Maciej, Pachlewski Jacek, Wronska Ewa, Bretthauer Michael, Thomas-Gibson Siwan, Kuipers Ernst J, Regula Jaroslaw
机构信息
Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
出版信息
Gut. 2016 Apr;65(4):616-24. doi: 10.1136/gutjnl-2014-307503. Epub 2015 Feb 10.
OBJECTIVE
Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.
DESIGN
40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤ 25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders' ADR. Mixed effect models using ORs and 95% CIs were computed.
RESULTS
The study included 24,582 colonoscopies performed by 38 leaders and 56,617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).
CONCLUSIONS
Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.
TRIAL REGISTRATION NUMBER
NCT01667198.
目的
结肠镜检查时腺瘤检出率（ADR）未达最佳水平与间隔期结直肠癌风险增加相关。目前尚不确定如何提高ADR。我们在一项全国性随机试验中比较了领导力培训与仅给予反馈对结肠镜检查质量的影响。
设计
在波兰筛查项目中表现欠佳的40个结肠镜检查筛查中心（2011年1月至12月干预前阶段中心负责人的ADR≤25%）被随机分为“培训结肠镜检查领导者”（TCLs）项目组（评估、实践培训、培训后反馈）或仅给予反馈组（个体质量指标）。2012年6月至12月（干预后早期）和2013年1月至12月（干预后晚期）进行的结肠镜检查用于计算质量指标的变化。主要结局是负责人ADR的变化。使用比值比（OR）和95%置信区间（CI）计算混合效应模型。
结果
该研究纳入了参与中心38位负责人进行的24,582例结肠镜检查以及138位内镜医师进行的56,617例结肠镜检查。TCL组和反馈组负责人ADR平均改善的绝对差异在干预后早期分别为7.1%和4.2%，在干预后晚期分别为7.1%和4.2%。TCL组在干预后早期（OR 1.61；95% CI 1.29至2.01；p<0.001）和晚期（OR 1.35；95% CI 1.10至1.66；p = 0.004）ADR改善更大。在干预后晚期，TCL组和反馈组整个中心ADR平均改善的绝对差异为3.9%（OR 1.25；95% CI 1.04至1.50；p = 0.017）。
结论
对结肠镜检查培训中的中心负责人进行教学可改善筛查结肠镜检查的重要质量指标。
试验注册号
NCT01667198。
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