Clinical trial · Observational
Improving Colonoscopy Quality for Colorectal Cancer Screening in the National VA Healthcare System
NCT04389957CI-TRIAL-00090368completedResults postedClinicalTrials.gov clinicaltrialsProvenance
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 8, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260908-000001
Summary
Brief summary (as posted)
High quality screening colonoscopy is critical for colorectal cancer (CRC) prevention in Veterans. There is significant variability in colonoscopy quality in VA that is directly linked to differences in CRC incidence and death. The investigators developed the VA Endoscopy Quality Improvement Program (VA-EQuIP) that the National GI program office will implement using centralized quality measurement and reporting for adenoma detection rates (ADR), bi-annual audit and feedback with provider benchmarking to local and national performance, and collaborative learning to support colonoscopy quality improvement. Using a cluster randomized controlled trial, the investigators will study the implementation of VA-EQuIP and determine the efficacy of its intervention on adenoma detection rates, which are directly linked to CRC incidence and death.
Conditions
Conditions (1)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Colorectal Neoplasms | Colorectal Neoplasm | ONTOLOGY_EXACT | 0.98 |
Interventions
Interventions (1)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| Veterans Affairs Endoscopy Quality Improvement Program (VA-EQuIP) | Other | — | UNRESOLVED |
Design
Arms and outcomes
Arms (1)
- label
- Endoscopy Providers
- description
- 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.
- interventionNames
- Other: Veterans Affairs Endoscopy Quality Improvement Program (VA-EQuIP)
Primary outcomes (1)
- measure
- Provider Adenoma Detection Rate (for All Colonoscopies)
- 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.
- description
- 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.
Secondary outcomes (2)
Eligibility
Eligibility (as posted)
- Sex
- All
- Minimum age
- 18 Years
Show eligibility criteria text
Inclusion Criteria: * Quantitative surveys will be delivered to endoscopy or GI section chiefs responsible for endoscopy services for each enrolled site. * Qualitative interviews will be conducted with GI section chiefs and individual endoscopists at participating facilities. * A list of criteria for selection of participants in the clinical study, provided in terms of inclusion and exclusion criteria is suitable for assisting potential participants in identifying clinical studies of interest. * All VA facilities with existing colonoscopy procedure or pathology notes in our operational database. Exclusion Criteria: -VA facilities without existing colonoscopy procedure or pathology notes in our operational database will not be included in the study.
References
Publications (10)
- BACKGROUNDGawron AJ, Yao Y, Gupta S, Cole G, Whooley MA, Dominitz JA, Kaltenbach T. Simplifying Measurement of Adenoma Detection Rates for Colonoscopy. Dig Dis Sci. 2021 Sep;66(9):3149-3155. doi: 10.1007/s10620-020-06627-2. Epub 2020 Oct 8. PMID 33029706
- BACKGROUNDGawron AJ, Sultan S, Glorioso TJ, Califano S, Kralovic SM, Jones M, Kirsh S, Dominitz JA. Pre-endoscopy coronavirus disease 2019 screening and severe acute respiratory syndrome coronavirus-2 nucleic acid amplification testing in the Veterans Affairs healthcare system: clinical practice patterns, outcomes, and relationship to procedure volume. Gastrointest Endosc. 2022 Sep;96(3):423-432.e7. doi: 10.1016/j.gie.2022.04.018. Epub 2022 Apr 22. PMID 35461889
- BACKGROUNDGawron AJ, Dominitz JA. Higher Quality Colonoscopy: Worth the Wait? Clin Transl Gastroenterol. 2022 Apr 1;13(4):e00471. doi: 10.14309/ctg.0000000000000471. PMID 35297791
- BACKGROUNDGupta S, Earles A, Bustamante R, Patterson OV, Gawron AJ, Kaltenbach TR, Yassin H, Lamm M, Shah SC, Saini SD, Fisher DA, Martinez ME, Messer K, Demb J, Liu L. Adenoma Detection Rate and Clinical Characteristics Influence Advanced Neoplasia Risk After Colorectal Polypectomy. Clin Gastroenterol Hepatol. 2023 Jul;21(7):1924-1936.e9. doi: 10.1016/j.cgh.2022.10.003. Epub 2022 Oct 19. PMID 36270618
- BACKGROUNDDemb J, Liu L, Bustamante R, Dominitz JA, Earles A, Shah SC, Gawron AJ, Martinez ME, Gupta S. COVID-19 Pandemic Had Minimal Impact on Colonoscopy Completion After Colorectal Cancer Red Flag Sign or Symptoms in US Veterans. Dig Dis Sci. 2023 Apr;68(4):1208-1217. doi: 10.1007/s10620-022-07685-4. Epub 2022 Sep 28. PMID 36169748
- BACKGROUNDGawron AJ, Bailey T, Codden R, Dominitz J, Gupta S, Helfrich C, Kahi C, Krop L, Malvar C, McKee G, Millar M, Mog A, Nguyen-Vu T, Patterson O, Presson AP, Saini S, Whooley M, Yao Y, Zickmund S, Kaltenbach T. Improving colonoscopy quality in the national VA healthcare system. Contemp Clin Trials. 2025 Feb;149:107784. doi: 10.1016/j.cct.2024.107784. Epub 2024 Dec 25.