An educational intervention to improve quality of care in Barrett's esophagus: the AQUIRE randomized controlled trial.

Abstract BACKGROUND and AIMS Despite quality measures in upper endoscopy (EGD) for Barrett’s esophagus (BE), there remains considerable variability in practice among gastroenterologists. This randomized controlled trial evaluated the role of structured intensive training on the quality of EGD in BE. METHODS In this multicenter study, 8 sites (from GI Quality Consortium) were cluster randomized (1:1) to receive AQUIRE (A Quality Improvement program in cancer care during endoscopy) training (intervention), or continue local standard practices (control). The primary outcome was adherence to the Seattle biopsy protocol. Secondary outcomes included (1) change in knowledge of BE detection and sampling, assessed by questionnaire and (2) dysplasia detection rate (DDR), before and after completion of the 6-month study period. RESULTS The intervention sites (n=4) had a total of 31 gastroenterologists and the control sites (n=4) had 34. There was a significant improvement in the adherence rates to Seattle biopsy protocol from baseline to the end of the study in the intervention sites (64.8% to 73.2%, p=0.002) but not in control sites (69.5% to 69.4%, p=0.953). The accurate response rate on the questionnaire at intervention sites increased from 73% at baseline to 88% post-AQUIRE training (diff: 14.8%; SD: 18.7, p=0.008). There was no significant change in DDR from baseline to 6 months in both control and intervention groups (p=0.06). CONCLUSIONS This study confirms the capacity of a structured educational intervention to improve utilization of standard biopsy protocol and knowledge of standards of care in BE, but no significant change in dysplasia detection rate.