Mo1077 Extensive Mucosal Atrophy Quantified by Serum Pepsinogen Levels Can Predict Metachronous Gastric Cancer Development After Endoscopic Resection Regardless of Helicobacter pylori Eradication

Abstract

INTRODUCTION: Quality in endoscopy is critical to ensure improved patient outcomes in colorectal cancer screening. The Global Rating Scale (GRS) was developed in the UK to provide metrics for quality in endoscopy and, although never formally validated, has been associated with improved patient outcomes nationally. AIMS &METHODS: To psychometrically test the adapted Canadian version of the Global Rating scale (GRS-C), in view of its deployment by the Canadian Association of Gastroenterology throughout the country to participating endoscopy units. The GRS-C was assessed at 3 separate institutions by endoscopy unit physicians, endoscopy nurses, and administrative personnel. The psychometric properties evaluated included validity, reliability, and responsiveness to change. For face validity, a group comprising staff not familiar with the GRS was assembled. Each of the groups then responded to the questions of the GRS-C that span 12 items. Content validity was assessed by comparing GRS-C questions to national quality indicators in endoscopy, while construct validity was determined by associating questions of the GRS-C with those of its original UK GRS counterpart. The GRS-C was completed at the 3 sites both at time 0 and 2 weeks later, with no intervening change to processes, as well as 6 months later after practice changes had been implemented as a result of patient satisfaction questionnaire responses, to respectively assess test-retest reliability and responsiveness to change. Descriptive and inferential data analyses were completed, including kappa values for agreement and paired assessments when comparing question responses. RESULTS: Face validity was demonstrated as the majority of participants were able to accurately identify the overarching theme each item was intended to measure. For content validity, 18 of 23 key quality indicators (78%, 95% CI: 56-93%) determined by an expert consensus group were addressed in the GRS-C. Statements not included related to educational programs and monitoring of competency. When comparing GRS-C and GRS-UK ratings for all 3 sites, concordance ranged from 75-100% across all three sites, while Kappa agreement levels on test-retest reliability ranged from 0.65 to 0.83. Following a series of process change initiatives, responsiveness to change in 6-month post-implementation scores were statistically higher (P<.001) in two endoscopy units. CONCLUSION: The GRS-C appears to exhibit satisfactory psychometric properties that can be used as part of a national quality initiative aimed at improving processes in endoscopy units. Linking GRS scores to actual patient outcomes is required to ensure that GRS-C implementation helps to achieve improved patient care.