Trial Outcomes & Findings for Improving Colonoscopy Quality for Colorectal Cancer Screening in the National VA Healthcare System (NCT NCT04389957)
NCT ID: NCT04389957
Last Updated: 2025-05-30
Results Overview
Adenoma detection rate is a provider level quality metric. For individual endoscopy providers, the numerator is the number of patients undergoing colonoscopy for any indication in which one or more adenomatous polyps were removed. The denominator is the total number of patients undergoing colonoscopy for each individual provider. Data will be obtained from our operational database for quality measurement and reporting.
Recruitment status
COMPLETED
Target enrollment
445 participants
Primary outcome timeframe
Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site, and post-intervention timepoint defined as beginning 3 months post dashboard release and concluding 6/30/23.
Results posted on
2025-05-30
Participant Flow
Sites could be included in the study if we could identify colonoscopy procedure and pathology notes in the VA central data warehouse (CDW) database for providers at the site. Of the 151 VA sites, there were 68 sites with reliable colonoscopy and pathology data from the CDW with 98,442 procedures from 445 providers. In the post-intervention time frame, we collected data from 129,972 procedures and 392 providers.
Unit of analysis: VA-EQuIP Sites
Participant milestones
| Measure |
Wedge 1 - 6 Months Baseline, 24 Months VA-EQuIP
Wedge 1 included 14 sites and 84 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 2 - 9 Months Baseline, 21 Months VA-EQuIP
Wedge 2 included 14 sites and 83 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 3 - 12 Months Baseline, 18 Months VA-EQuIP
Wedge 3 included 14 sites and 93 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 4 - 15 Months Baseline, 15 Months VA-EQuIP
Wedge 4 included 13 sites and 97 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 5 - 18 Months Baseline, 12 Months VA-EQuIP
Wedge 5 included 13 sites and 88 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
|---|---|---|---|---|---|
|
Overall Study
STARTED
|
84 14
|
83 14
|
93 14
|
97 13
|
88 13
|
|
Overall Study
COMPLETED
|
77 14
|
76 14
|
81 14
|
77 13
|
81 13
|
|
Overall Study
NOT COMPLETED
|
7 0
|
7 0
|
12 0
|
20 0
|
7 0
|
Reasons for withdrawal
| Measure |
Wedge 1 - 6 Months Baseline, 24 Months VA-EQuIP
Wedge 1 included 14 sites and 84 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 2 - 9 Months Baseline, 21 Months VA-EQuIP
Wedge 2 included 14 sites and 83 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 3 - 12 Months Baseline, 18 Months VA-EQuIP
Wedge 3 included 14 sites and 93 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 4 - 15 Months Baseline, 15 Months VA-EQuIP
Wedge 4 included 13 sites and 97 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
Wedge 5 - 18 Months Baseline, 12 Months VA-EQuIP
Wedge 5 included 13 sites and 88 providers. Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site. The intervention began at dashboard release and concluded in 6/30/23. The post-intervention timepoint was defined as beginning 3 months post dashboard release to 6/30/23.
|
|---|---|---|---|---|---|
|
Overall Study
Providers without data in the post intervention timeframe.
|
7
|
7
|
12
|
20
|
7
|
Baseline Characteristics
Information about age was unavailable for 5 providers.
Baseline characteristics by cohort
| Measure |
Providers
n=445 Participants
In the primary analysis model, there were 68 sites with usable data with 98,442 procedures from 445 providers in the pre-intervention time frame and 129,972 procedures from 392 providers in the post-intervention time frame.
|
|---|---|
|
Age, Customized
Age Groups · 39 years or younger
|
97 Participants
n=440 Participants • Information about age was unavailable for 5 providers.
|
|
Age, Customized
Age Groups · 40-49 years
|
129 Participants
n=440 Participants • Information about age was unavailable for 5 providers.
|
|
Age, Customized
Age Groups · 50-59 years
|
94 Participants
n=440 Participants • Information about age was unavailable for 5 providers.
|
|
Age, Customized
Age Groups · 60 years or older
|
120 Participants
n=440 Participants • Information about age was unavailable for 5 providers.
|
|
Sex: Female, Male
Female
|
116 Participants
n=439 Participants • Information about sex was unavailable for 6 providers
|
|
Sex: Female, Male
Male
|
323 Participants
n=439 Participants • Information about sex was unavailable for 6 providers
|
|
Region of Enrollment
United States · Continental
|
40 Participants
n=445 Participants
|
|
Region of Enrollment
United States · Midwest
|
136 Participants
n=445 Participants
|
|
Region of Enrollment
United States · North Atlantic
|
99 Participants
n=445 Participants
|
|
Region of Enrollment
United States · Pacific
|
103 Participants
n=445 Participants
|
|
Region of Enrollment
United States · Southeast
|
67 Participants
n=445 Participants
|
|
Specialty
Gastroenterology
|
390 Participants
n=445 Participants
|
|
Specialty
Surgery
|
55 Participants
n=445 Participants
|
|
Years since completion of medical degree
Less than 10 years
|
49 Participants
n=418 Participants • Information about completion of medical degree was unavailable for 27 providers.
|
|
Years since completion of medical degree
10-19 years
|
128 Participants
n=418 Participants • Information about completion of medical degree was unavailable for 27 providers.
|
|
Years since completion of medical degree
20-29 years
|
99 Participants
n=418 Participants • Information about completion of medical degree was unavailable for 27 providers.
|
|
Years since completion of medical degree
30-39 years
|
83 Participants
n=418 Participants • Information about completion of medical degree was unavailable for 27 providers.
|
|
Years since completion of medical degree
40 or more years
|
59 Participants
n=418 Participants • Information about completion of medical degree was unavailable for 27 providers.
|
PRIMARY outcome
Timeframe: Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site, and post-intervention timepoint defined as beginning 3 months post dashboard release and concluding 6/30/23.Population: We assessed the adenoma detection rate of 445 providers in the pre-intervention time frame and 392 providers in the post-intervention time frame.
Adenoma detection rate is a provider level quality metric. For individual endoscopy providers, the numerator is the number of patients undergoing colonoscopy for any indication in which one or more adenomatous polyps were removed. The denominator is the total number of patients undergoing colonoscopy for each individual provider. Data will be obtained from our operational database for quality measurement and reporting.
Outcome measures
| Measure |
Wedge 1
n=14 VA-EQuIP Sites
Wedge 1 included 14 sites and 84 providers in the pre-intervention time frame and 14 sites and 77 providers in the post-intervention time frame.
|
Wedge 2
n=14 VA-EQuIP Sites
Wedge 2 included 14 sites and 83 providers in the pre-intervention time frame and 14 sites and 76 providers in the post-intervention time frame.
|
Wedge 3
n=14 VA-EQuIP Sites
Wedge 3 included 14 sites and 93 providers in the pre-intervention time frame and 14 sites and 81 providers in the post-intervention time frame.
|
Wedge 4
n=13 VA-EQuIP Sites
Wedge 4 included 13 sites and 97 providers in the pre-intervention time frame and 13 sites and 77 providers in the post-intervention time frame.
|
Wedge 5
n=13 VA-EQuIP Sites
Wedge 5 included 13 sites and 88 providers in the pre-intervention time frame and 13 sites and 81 providers in the post-intervention time frame.
|
|---|---|---|---|---|---|
|
Provider Adenoma Detection Rate (for All Colonoscopies)
Pre-Intervention
|
52.7 % of colonoscopies w/ 1+ adenomas
Standard Deviation 13.7
|
46.9 % of colonoscopies w/ 1+ adenomas
Standard Deviation 12.4
|
43.5 % of colonoscopies w/ 1+ adenomas
Standard Deviation 15.0
|
42.8 % of colonoscopies w/ 1+ adenomas
Standard Deviation 18.2
|
45.6 % of colonoscopies w/ 1+ adenomas
Standard Deviation 12.3
|
|
Provider Adenoma Detection Rate (for All Colonoscopies)
Post-Intervention
|
50.9 % of colonoscopies w/ 1+ adenomas
Standard Deviation 16.7
|
52.0 % of colonoscopies w/ 1+ adenomas
Standard Deviation 12.6
|
46.2 % of colonoscopies w/ 1+ adenomas
Standard Deviation 11.2
|
49.5 % of colonoscopies w/ 1+ adenomas
Standard Deviation 14.3
|
50.9 % of colonoscopies w/ 1+ adenomas
Standard Deviation 12.6
|
SECONDARY outcome
Timeframe: Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site, and post-intervention timepoint defined as beginning 3 months post dashboard release and concluding 6/30/23.Population: We assessed bowel preparation quality of 445 providers in the pre-intervention time frame and 392 providers in the post-intervention time frame.
Bowel preparation quality is determined by each endoscopist for bowel cleanliness allowing polyp visualization and removal. Bowel preparation quality is measured as Adequate or Inadequate by our quality reporting system. For each provider, bowel preparation quality will be calculated with the numerator equal to all colonoscopies with "adequate" preparation quality divided by the denominator of all colonoscopies performed by the provider.
Outcome measures
| Measure |
Wedge 1
n=84 Participants
Wedge 1 included 14 sites and 84 providers in the pre-intervention time frame and 14 sites and 77 providers in the post-intervention time frame.
|
Wedge 2
n=83 Participants
Wedge 2 included 14 sites and 83 providers in the pre-intervention time frame and 14 sites and 76 providers in the post-intervention time frame.
|
Wedge 3
n=93 Participants
Wedge 3 included 14 sites and 93 providers in the pre-intervention time frame and 14 sites and 81 providers in the post-intervention time frame.
|
Wedge 4
n=97 Participants
Wedge 4 included 13 sites and 97 providers in the pre-intervention time frame and 13 sites and 77 providers in the post-intervention time frame.
|
Wedge 5
n=88 Participants
Wedge 5 included 13 sites and 88 providers in the pre-intervention time frame and 13 sites and 81 providers in the post-intervention time frame.
|
|---|---|---|---|---|---|
|
Bowel Preparation Quality (Provider Level)
Pre-Intervention · 85% or greater
|
65 Participants
|
62 Participants
|
45 Participants
|
47 Participants
|
44 Participants
|
|
Bowel Preparation Quality (Provider Level)
Post-Intervention · 85% or greater
|
57 Participants
|
60 Participants
|
45 Participants
|
30 Participants
|
53 Participants
|
|
Bowel Preparation Quality (Provider Level)
Pre-Intervention · Less than 85%
|
19 Participants
|
21 Participants
|
48 Participants
|
50 Participants
|
44 Participants
|
|
Bowel Preparation Quality (Provider Level)
Post-Intervention · Less than 85%
|
20 Participants
|
16 Participants
|
36 Participants
|
47 Participants
|
28 Participants
|
SECONDARY outcome
Timeframe: Our intervention effect was estimated with the pre-intervention timepoint defined as 1/1/21 through dashboard release at the site, and post-intervention timepoint defined as beginning 3 months post dashboard release and concluding 6/30/23.Population: We assessed cecal intubation rate of 445 providers in the pre-intervention time frame and 392 providers for the post-intervention time frame.
Cecal intubation is a provider level quality metric. The cecal intubation rate is the proportion of colonoscopies with cecal intubation documented in the procedure note.
Outcome measures
| Measure |
Wedge 1
n=84 Participants
Wedge 1 included 14 sites and 84 providers in the pre-intervention time frame and 14 sites and 77 providers in the post-intervention time frame.
|
Wedge 2
n=83 Participants
Wedge 2 included 14 sites and 83 providers in the pre-intervention time frame and 14 sites and 76 providers in the post-intervention time frame.
|
Wedge 3
n=93 Participants
Wedge 3 included 14 sites and 93 providers in the pre-intervention time frame and 14 sites and 81 providers in the post-intervention time frame.
|
Wedge 4
n=97 Participants
Wedge 4 included 13 sites and 97 providers in the pre-intervention time frame and 13 sites and 77 providers in the post-intervention time frame.
|
Wedge 5
n=88 Participants
Wedge 5 included 13 sites and 88 providers in the pre-intervention time frame and 13 sites and 81 providers in the post-intervention time frame.
|
|---|---|---|---|---|---|
|
Cecal Intubation Rate (Provider Level) - Revision
Pre-Intervention · Less than 90%
|
16 Participants
|
22 Participants
|
41 Participants
|
51 Participants
|
31 Participants
|
|
Cecal Intubation Rate (Provider Level) - Revision
Pre-Intervention · 90% and greater
|
68 Participants
|
61 Participants
|
52 Participants
|
46 Participants
|
57 Participants
|
|
Cecal Intubation Rate (Provider Level) - Revision
Post-Intervention · Less than 90%
|
17 Participants
|
7 Participants
|
32 Participants
|
31 Participants
|
36 Participants
|
|
Cecal Intubation Rate (Provider Level) - Revision
Post-Intervention · 90% and greater
|
60 Participants
|
69 Participants
|
49 Participants
|
46 Participants
|
45 Participants
|
Adverse Events
Providers
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Dr. Tonya Kaltenbach
San Francisco Veterans Affairs Medical Center
Phone: (415) 221-4810
Email: [email protected]
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place