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Assessment of the quality of colonoscopy reports: results from a multicenter consortium.

Lieberman DA, Faigel DO, Logan JR, Mattek N, Holub J, Eisen G, Morris C, Smith R, Nadel M. Assessment of the quality of colonoscopy reports: results from a multicenter consortium. Gastrointestinal endoscopy. 2009 Mar 1; 69(3 Pt 2):645-53.

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Abstract:

BACKGROUND: To improve colonoscopy quality, reports must include key quality indicators that can be monitored. OBJECTIVE: To determine the quality of colonoscopy reports in diverse practice settings. SETTING: The consortium of the Clinical Outcomes Research Initiative, which includes 73 U.S. gastroenterology practice sites that use a structured computerized endoscopy report generator, which includes fields for specific quality indicators. DESIGN: Prospective data collection from 2004 to 2006. MAIN OUTCOMES MEASUREMENTS: Reports were queried to determine if specific quality indicators were recorded. Specific end points, including quality of bowel preparation, cecal intubation rate, and detection of polyp(s) > 9 mm in screening examinations were compared for 53 practices with more than 100 colonoscopy procedures per year. RESULTS: Of the 438,521 reports received during the study period, 13.9% did not include bowel-preparation quality and 10.1% did not include comorbidity classification. The overall cecal intubation rate was 96.3%, but cecal landmarks were not recorded in 14% of the reports. Missing polyp descriptors included polyp size (4.9%) and morphology (14.7%). Reporting interventions for adverse events during the procedure varied from 0% to 6.5%. Among average-risk patients who received screening examinations, the detection rate of polyps > 9 mm, adjusted for age, sex, and race, was between 4% and 10% in 81% of practices. LIMITATION: Bias toward high rates of reporting because of the standard use of a computerized report generator. CONCLUSIONS: There is significant variation in the quality of colonoscopy reports across diverse practices, despite the use of a computerized report generator. Measurement of quality indicators in clinical practice can identify areas for quality improvement.





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