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BACKGROUND/RATIONALE:
Colonoscopy is used for primary colorectal cancer (CRC) screening, surveillance of patients with prior colon neoplasia or cancer and for diagnosis in patients with lower gastrointestinal (GI) tract symptoms or positive fecal occult blood test (FOBT). There is evidence that utilization of colonoscopy has increased dramatically in the past few years, largely due to increased rates of CRC screening. The effectiveness and safety of colonoscopy depends on the quality of examination, and a growing body of evidence suggests that the quality of colonoscopy in clinical practice varies. Quality of colonoscopy in VA medical centers is unknown.
In 2002, the Multi-Society Task Force on colorectal cancer (MSTF-CRC) published specific recommendations to improve the quality and effectiveness of colonoscopy. In 2007, the Quality Assurance Task Force of the National Colorectal Cancer Roundtable developed a colonoscopy reporting and data system (CO-RADS) to assist endoscopists in monitoring quality indicators in their practice. Structured, computerized endoscopic reporting systems provide an ideal tool for monitoring quality indicators. The Clinical Outcomes Research Initiative (CORI) developed a computerized endoscopic reporting system to study outcomes and quality of endoscopy in the United States. Data are transmitted electronically to a central data repository for analysis. The CORI consortium includes 70 diverse practice sites (including 9 VA centers) in 24 states, and receives about 260,000 endoscopic reports annually.
OBJECTIVE(S):
To determine if specific quality indicators are being reported by endoscopists at VA centers, and to measure actual performance relative to specific targets.
Aim 1: Measure adherence to completion of specific quality indicators for colonoscopy in 9 VA medical centers (2004-2007)
Hypothesis: There will be practice variation among endoscopists and areas for quality improvement will be identified
Aim 2: Measure actual performance relative to specific targets in the VA centers. Results will be compared to outcomes in non-VA centers which participate in CORI
Hypothesis: There will be practice variation. VA endoscopists will be similar to non-VA physicians in performance. Areas of quality improvement will be identified.
METHODS:
This study will analyze prospectively collected data from nine participating VA centers in the Clinical Outcomes Research Initiative (CORI) during the time period of January 1, 2004 through December 31, 2007. All VAMC endoscopists who perform more than 100 colonoscopy exams per year (2 per week) will be included in the analysis. We will query the database to identify specific quality indicators and analyze on a per-provider basis. We will determine if the specific field was completed (Aim #1) and if so, we will measure the specific outcome. We will also compare quality indicators among VA sites to non-VA sites overall. More than 600,000 colonoscopies were contributed to CORI between 2004 and 2007. The VA sample (66,000) represents 11% of the reports.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
This study will provide valuable quality assurance data to the VA, and enable quality improvement programs in colonoscopy.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Prevention, Diagnosis and Prognosis
Keywords:
Cancer, Quality assessment, Quality Measure
MeSH Terms:
none
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