Quality assessment of FIT screening in the Netherlands

Manon Spaander, MD PhD Regional coordinator in the National

Bowel Cancer Screening Program – The Netherlands

Possible conflicts of interest

• No conflicts of interest

Manon C.W. Spaander

The Dutch national CRC screening program

Manon C.W. Spaander

• Five region Screening Organization:

- Implementation of the program: – - Question clients and health providers

– - Capacity colonoscopy resources

- Regional Coordinator Gastroenterologist (RCMDL) - - Certifying endoscopy services

- - Quality assurance screening endoscopist and endoscopy services

Quality assurance endoscopy services and endoscopists

Manon C.W. Spaander

• Start audit: approval to perform screening colonoscopies

• Periodic audit: quality assurance endoscopist

• Periodic audit: quality assurance endoscopist

• Re-audit: approval endoscopy service continuing screening

Three domains of colonoscopy quality

Manon Spaander Lee et al. Gut 2012; 61: 1050-7

Technical domain Key perform indicators

• Cecal intubation rate ≥ 95%

• Withdrawal time ≥ 6 minutes

in negative colonoscopies ≥ 90%

• Adenoma detection rate ≥ 25%

• BBPS ≥6 ≥ 90%

Name of presenter

Results colonoscopies 2015

Manon C.W. Spaander

10,110 24%

4213 [PERCENTAGE]

8,846 [PERCENTAGE]

8,846 [PERCENTAGE]

10,110 [PERCENTAGE] Midden-West

Noord

Oost

Zuid

Zuid-West

N= 42.128

Complete colonoscopies 97%

Manon C.W. Spaander

95,0%

95,5%

96,0%

96,5%

97,0%

97,5%

Midden-West Noord Oost Zuid Zuid-West

% Complete colonoscopies n= 40.209

Incomplete colonoscopies n= 1.156

Manon C.W. Spaander

Most common reasons:

• 30% stricture or stenosis

• 23% looping

• 17% inappropriate bowel cleaning

• 9% pain

Withdrawal time

• 12% complete negative colonoscopy

• 97% withdrawal time was ≥ 6 minutes

Manon C.W. Spaander

Colonoscopies with polypectomy 77%

Manon C.W. Spaander

71,0%

72,0%

73,0%

74,0%

75,0%

76,0%

77,0%

78,0%

79,0%

80,0%

81,0%

Midden-West Noord Oost Zuid Zuid-West

% Coloscopies with polypectomie

Colonoscopies with advanced adenoma 38.8%

Manon C.W. Spaander

34,0%

35,0%

36,0%

37,0%

38,0%

39,0%

40,0%

41,0%

42,0%

Midden-West Noord Oost Zuid Zuid-West

% Coloscopieën met 'advanced' adenoom

MAP 1.7 and MAP+ 2.5

Manon C.W. Spaander

0,0

0,5

1,0

1,5

2,0

2,5

3,0

3,5

4,0

Midden-West Noord Oost Zuid Zuid-West

MAP+

Colonoscopies with non-advanced adenoma 28.8%

Manon C.W. Spaander

26,5%

27,0%

27,5%

28,0%

28,5%

29,0%

29,5%

30,0%

30,5%

31,0%

31,5%

Midden-West Noord Oost Zuid Zuid-West

% Coloscopieën with non-advanced adenoma

CRC was found in 8%

Manon C.W. Spaander

7,4%

7,6%

7,8%

8,0%

8,2%

8,4%

8,6%

Midden-West Noord Oost Zuid Zuid-West

% Coloscopies with CRC

Patient safety and experience domain

Severe complications:

• Bleeding 0.04 %

• Perforation 0.05 %

• Other 0.02 %

Gloucester Comfort Score ≥ 4 4 %

Name of presenter

Conclusion: Quality of colonoscopies in the Dutch CRC screening program

• High-quality colonoscopy as demonstrated by:

– High caecal intubation rate

– ADR

– Comfort scores

– Low adverse event rates

• Fulfilled the current national and international colonoscopy quality standards.

Manon C.W. Spaander