Advertisement

Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group

      Background

      There is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level.

      Objective

      To evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation.

      Design

      Observational cross-sectional analysis.

      Setting

      Collaborative quality metrics database from 2007 to 2012.

      Patients

      Patients who underwent colonoscopies in ambulatory surgery centers.

      Interventions

      Colonoscopy.

      Main Outcome Measurements

      The number of colonoscopies with an adenomatous polyp divided by the total number of colonoscopies (ADR-T), inclusive of indication and patient's sex.

      Results

      Data from 368,157 colonoscopies were included for analysis from 11 practices. Three practice sites (5, 8, and 10) were significantly above and 2 sites (3, 7) were significantly below mean ADR-T, with a 95% confidence interval (CI). High-performing sites had 9.0% higher ADR-T than sites belonging to the lowest quartile (P < .001). The mean ADR-T remained stable for 9 of 11 sites. Regression analysis showed that the 2 practice sites where ADR-T varied had significant improvements in ADR-T during the 6-year period. For each, mean ADR-T improved an average of 0.5% per quarter for site 2 (P = .001) and site 3 (P = .021), which were average and low performers, respectively.

      Limitations

      Summary-level data, which does not allow cross-reference of variables at an individual level.

      Conclusion

      We found performance disparities among practice sites remaining relatively consistent over a 6-year period. The ability of certain sites to sustain their high-performance over 6 years suggests that further research is needed to identify key organizational processes and physician incentives that improve the quality of colonoscopy.

      Abbreviations:

      ADR (adenoma detection rate), ADR-T (adenoma detection rate-total), ASC (ambulatory surgery centers), GPMG (Gastroenterology Practice Management Group), IT (information technologies)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. MedPAC. Ambulatory surgical center services: assessing payment adequacy and updating payments. MedPAC data book, June 2006. Available at: http://www.medpac.gov/chapters/Mar12_Ch05.pdf. Accessed October 2013.

        • Kaminski M.F.
        • Regula J.
        • Kraszewska E.
        • et al.
        Quality indicators for colonoscopy and the risk of interval cancer.
        N Engl J Med. 2010; 362: 1795-1803
        • Hernandez L.V.
        • Allen J.I.
        • Klyve D.
        • et al.
        Colonoscopy quality indicators from a nationwide consortium of GI practices.
        Gastrointest Endosc. 2011; 73 ([abstract]): AB396
      2. Medicare Claims Processing Manual. Chapter 14. Available at: http://www.cms.gov/Regulations-and-guidance/guidance/manuals/downloads/clm104c14.pdf. Accessed September 2013.

        • Rex D.K.
        • Hewett D.G.
        • Raghavendra M.
        • et al.
        The impact of video recording on the quality of colonoscopy performance: a pilot study.
        Am J Gastroenterol. 2010; 105: 2312-2317
        • Mehrotra A.
        • Dellon E.S.
        • Schoen R.E.
        • et al.
        Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures.
        Gastrointest Endosc. 2012; 75: 1233-1239
      3. GI Quality Improvement Consortium. Available at: http://giquic.gi.org/index.asp. Accessed September 2013.

        • Hing E.
        • Hall M.J.
        • Ashman J.J.
        Use of electronic medical records by ambulatory care providers: United States, 2006.
        Natl Health Stat Report. 2010; 22: 1-21
        • Adler A.
        • Wegscheider K.
        • Lieberman D.
        • et al.
        Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3).
        Gut. 2013; 62: 236-241
        • Chen S.C.
        • Rex D.K.
        Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy.
        Am J Gastroenterol. 2007; 102: 856-861
        • Corley D.A.
        • Jensen C.D.
        • Marks A.R.
        Can we improve adenoma detection rates? A systematic review of intervention studies.
        Gastrointest Endosc. 2011; 74: 656-665