A new quality indicator of colonoscopy: caveat emptor

Abstract

Quality indicators of health care should measure endpoints that closely reflect patient outcomes. Further, they should be feasible to measure accurately in clinical practice and demonstrate evidence of variable performance. An additional important consideration is the potential for a candidate quality indicator to distort provider behavior in ways that could adversely affect patient outcomes or costs of care or that could be gamed, where the target measure is achieved but without reflecting high-quality care. “Gaming” in reference to quality indicators refers to behaviors that help satisfy the target set for the indicator but do not improve and are likely to detract from optimal or the most cost-effective patient care.