# Improving Colonoscopy Quality in the National VA Healthcare System

> **NIH VA I01** · VA SALT LAKE CITY HEALTHCARE SYSTEM · 2020 · —

## Abstract

Colorectal cancer (CRC) prevention is a top VA priority. The effectiveness of screening colonoscopy in CRC
prevention relies on its quality. The adenoma detection rate (ADR), defined as the proportion of screening
colonoscopies performed by a physician that has one or more histologically-confirmed adenomatous polyps or
CRC, is the primary benchmark for colonoscopy inspection quality. Increased ADR correlates with a lower risk
of CRC incidence and mortality in large studies, including our recent VA data. An Office of the Inspector
General (OIG) report highlighted colonoscopy quality deficiencies in VA, and strongly recommended that the
“Acting Under Secretary for Health require standardized documentation of quality indicators based on
professional society guidelines and published literature.” Currently, VA cannot ensure Veterans receive high
quality colonoscopy for CRC prevention, as there is no automated mechanism to continually measure or report
quality. We have developed the novel informatics infrastructure for centralized colonoscopy quality reporting
across VA, enabling implementation of the VA Endoscopy Quality Improvement Program (VA-EQuIP) to
directly address the OIG recommendations and VA’s critical need to implement evidence-based colonoscopy
quality measurement and reporting. The National Gastroenterology (GI) program office will implement VA-
EQuIP to provide VA sites and endoscopists with bi-annual audit and feedback of colonoscopy quality with
individual provider benchmarking to local and national performance and collaborative learning sessions
moderated by national experts in colonoscopy training and quality. The implementation of a novel program,
such as VA-EQuIP, is an opportunity to study the impact of a large-scale learning health system initiative.
The specific aims of this service directed research proposal are:
Aim 1: To determine if implementation of VA-EQuIP increases provider adenoma detection rates
compared to usual care.
 Aim 2a: To evaluate VA-EQuIP implementation and identify site level factors associated with
colonoscopy quality improvement.
Aim 2b: To explore and identify components of provider behavior change after VA-EQuIP
implementation.
We propose to evaluate the effect of VA-EQuIP implementation on colonoscopy performance using a cluster
randomized controlled trial to determine the efficacy of the intervention on overall ADRs and provider-level
ADRs. We will use a mixed-methods approach to evaluate the intervention in a multi-faceted manner to
evaluate implementation outcomes and components of provider behavior change. We are powered to identify
improvements in ADR of at least 1% for providers. This effect is clinically important, because each 1% increase
in ADR is associated with a decreased risk of 3% for CRC incidence and 5% for CRC death. Our approach to
standardized, transparent, automated quality reporting, coupled with collaborative learning, is a key initial step
to improve colonoscopy quality. We postul...

## Key facts

- **NIH application ID:** 9949305
- **Project number:** 1I01HX002778-01A2
- **Recipient organization:** VA SALT LAKE CITY HEALTHCARE SYSTEM
- **Principal Investigator:** Andrew J Gawron
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-06-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9949305

## Citation

> US National Institutes of Health, RePORTER application 9949305, Improving Colonoscopy Quality in the National VA Healthcare System (1I01HX002778-01A2). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9949305. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*