Decrease of variation in the grading of dysplasia in colorectal adenomas with a national e-learning module.

Autor: Madani A; Foundation PALGA (Dutch Pathology Registry), Houten, the Netherlands.; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.; Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands., Kuijpers CCHJ; Foundation PALGA (Dutch Pathology Registry), Houten, the Netherlands.; Department of Pathology, University Medical Centre, Utrecht, the Netherlands., Sluijter CE; Foundation PALGA (Dutch Pathology Registry), Houten, the Netherlands.; Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands., Von der Thüsen JH; Department of Pathology, Erasmus University Medical Centre, Rotterdam, the Netherlands., Grünberg K; Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands.; NVVP (Dutch Society of Pathology), Utrecht, the Netherlands., Lemmens VEPP; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.; Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands., Overbeek LIH; Foundation PALGA (Dutch Pathology Registry), Houten, the Netherlands., Nagtegaal ID; Foundation PALGA (Dutch Pathology Registry), Houten, the Netherlands.; Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Jazyk: angličtina
Zdroj: Histopathology [Histopathology] 2019 May; Vol. 74 (6), pp. 925-932. Date of Electronic Publication: 2019 Apr 01.
DOI: 10.1111/his.13834
Abstrakt: Aims: Variation in health-care is undesirable, as this is potentially harmful for patients. In the Netherlands, an e-learning module was developed to standardise pathological evaluation of colorectal adenomas. We studied the effect of e-learning on interlaboratory variability in grading of dysplasia in screened conventional colorectal adenomas.
Methods and Results: A cross-sectional retrospective study was performed, including all colorectal adenomas from the Dutch population-based colorectal cancer screening programme, retrieved from the Dutch Pathology Registry (PALGA) from January 2014 to July 2015. The e-learning tool, commissioned by the National Institute for Public Health, was implemented among screening pathologists from October 2014. Proportions of high-grade dysplasia (HGD) were compared before (January-July 2014) and after implementation (October 2014-July 2015) of the e-learning module. Interlaboratory variation was assessed by multilevel mixed-effects analysis. In total, 20 713 colonoscopies (20 546 patients) were performed after a positive faecal immunochemical screening test, resulting in the inclusion of 56 355 conventional adenomas from 37 pathology laboratories. Before implementation, 12 614 adenomas were diagnosed, including 4.3% with HGD. After implementation, 43 741 adenomas were diagnosed, and the HGD proportion decreased to 3.9%. Univariable analysis showed less deviant proportions of HGD after implementation in 62% of the laboratories (P = 0.019). Multilevel analysis confirmed decreased variation in the risk of diagnosing HGD (P = 0.021).
Conclusions: Interlaboratory variability in grading HGD in colorectal adenomas after a positive screening test decreased after implementation of an e-learning module for pathologists. We therefore conclude that e-learning has a favourable influence on decreasing diagnostic variability, making this a relevant strategy for health-care standardisation.
(© 2019 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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