Know the three priority quality indicators for colonoscopy to document, evaluate

WASHINGTON ─ There are four reasons to measure quality in colonoscopy: procedure standardization, medical-legal, insurer/payer reimbursement and GI society mandates, an expert said here at Digestive Disease Week 2015.

We use quality indicators in colonoscopy to help measure quality of care, Ian M. Gralnek, MD, MSHS, FASGE, from the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and chief, Institute of Gastroenterology and Liver Diseases, Ha’Emek Medical Center, Afula, Israel, said during his presentation.

There are three types of quality measures: structure measures (such as physician participation in continuous quality improvement [CQI] programs or as a part of an endoscopy registry); process measures (such as adenoma detection rate [ADR] or taking adequate biopsies in patients with ulcerative colitis who are undergoing colonoscopic surveillance); and outcome measures (such as can colorectal cancer prevention due to colonoscopic polypectomy), Gralnek said.

“Why is measuring quality of care in colonoscopy important today?” Gralnek said. “This allows us to try and standardize how we perform colonoscopy. It allows us to try and get at the clinical processes and practices that we as a group of practitioners should be doing very similarly.”

Quality of care also has medical-legal importance, he explained.

“Whether we like that or not that is the reality of 2015,” he said.

Quality measures have an impact on how health care providers are reimbursed for colonoscopies and this will only increase in importance over time. Also, the societies — ASGE, ACG and AGA — mandate quality measures, he said.

Gralnek centered his discussion on three priority quality indicators for colonoscopy.

“First, what is the frequency that adenomas are detected in asymptomatic, average risk individuals,” he said of the ADR. Gralnek said that GI units should have a process measure in place to measure each individual endoscopist’s ADR and have a CQI program in place to follow the rates and improve those endoscopists with lower ADRs.

Second, document and demonstrate that the frequency with which colonoscopies follow the recommended post-polypectomy and post-cancer resection for surveillance intervals; and conform to the recommended 10-year intervals between screening colonoscopies in average risk patients who have a negative examination, he said.

The third priority is the frequency with which intubation of the cecum is achieved , with appropriate notation of the anatomic landmarks and photo documentation of those landmarks is documented during every colonoscopy procedure, Gralnek said.

“This is what we should, at least at a minimum as providers be documenting and tracking within our endoscopy practices today in 2015.” – by Joan-Marie Stiglich, ELS

For more information: Gralnek IM. Sp351. Presented at: Digestive Disease Week; May 15-19, 2015; Washington, D.C.

Reference: Rizk MK. Gastrointest Endo. 2015; doi: 10.1016/j.gie.2014.07.055.

Disclosure: Gralnek reports no financial support.

Editor's note: This article was updated on May 27, 2015, to include clarifications from the presenter.