Factors Influencing Variation in Physician Adenoma Detection Rates: a Theory-Based Approach for Performance Improvement. Atkins L, Hunkeler EM, Jensen CD, Michie S, Lee JK, Doubeni CA, Zauber AG, Levin TR, Quinn VP, Corley DA. Gastrointest Endosc. 2015 Sep 11 [Epub ahead of print]
BACKGROUND & AIMS: Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence variation in detection rates using theory-based tools for understanding behavior. METHODS: We separately studied gastroenterologists and endoscopy nurses at three Kaiser Permanente Northern California medical centers to identify potentially modifiable factors relevant to physician adenoma detection rate variability using structured group interviews (focus groups) and theory-based tools for understanding behavior and eliciting behavior change: the Capability, Opportunity, and Motivation behavior model; the Theoretical Domains Framework; and the Behavior Change Wheel
. RESULTS: Nine factors potentially associated with detection rate variability were identified, including six related to capability (uncertainty about which types of polyps to remove; style of endoscopy team leadership; compromised ability to focus during an examination due to distractions; examination technique during withdrawal; difficulty detecting certain types of adenomas; and examiner fatigue and pain), two related to opportunity (perceived pressure due to the number of examinations expected per shift and social pressure to finish examinations before scheduled breaks or the end of a shift), and one related to motivation (valuing a meticulous examination as the top priority). Examples of potential intervention strategies are provided. CONCLUSIONS: Using theory-based tools, this study identified several novel and potentially modifiable factors relating to capability, opportunity, and motivation that may contribute to adenoma detection rate variability and be appropriate targets for future intervention trials.Leggi l’articolo