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

Abstract

Aims

Variation in health care is undesirable since this is potentially harmful for patients. In the Netherlands, an e‐learning module was developed to standardise pathologic 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 program, retrieved from the Dutch Pathology Registry (PALGA) from January 2014‐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 fecal 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 favorable influence on decreasing diagnostic variability, making this a relevant strategy for health care standardisation.

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