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

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. This article is protected by copyright. All rights reserved.