Ariana Madani1,2,3, Chantal C H J Kuijpers1,4, Caro E Sluijter1,5, Jan H Von der Thüsen6, Katrien Grünberg5,7, Valery E P P Lemmens2,3, Lucy I H Overbeek1, Iris D Nagtegaal1,5. 1. Foundation PALGA (Dutch Pathology Registry), Houten, the Netherlands. 2. Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands. 3. Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands. 4. Department of Pathology, University Medical Centre, Utrecht, the Netherlands. 5. Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands. 6. Department of Pathology, Erasmus University Medical Centre, Rotterdam, the Netherlands. 7. NVVP (Dutch Society of Pathology), Utrecht, the Netherlands.
Abstract
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.
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.
Authors: Marloes A Smit; Gabi W van Pelt; Elisabeth Mc Dequeker; Raed Al Dieri; Rob Aem Tollenaar; J Han Jm van Krieken; Wilma E Mesker Journal: JMIR Form Res Date: 2021-03-19
Authors: Lisanne J H Smits; Elisa Vink-Börger; Gesina van Lijnschoten; Isabelle Focke-Snieders; Rachel S van der Post; Jurriaan B Tuynman; Nicole C T van Grieken; Iris D Nagtegaal Journal: Histopathology Date: 2022-01-10 Impact factor: 7.778