Measurement Of Quality Indicators Research Articles

Using Quality Measures for Quality Improvement: The Perspective of Hospital Staff

Research objectiveThis study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals.Study designA cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness) indicators.Population studied93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran.Principal findingsOn average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05).ConclusionsThere is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and effectiveness indicators is needed to support internal quality improvement processes at hospital level.

The journey toward quality and patient safety in laboratory medicine continues.

Errors in laboratory medicine have a completely different meaning today than they had a century ago. At that time, the term referred to defects in the analytical performance of the test itself, the so-called analytical phase.[1] A dramatic change in addressing the issue of errors in laboratory medicine started at the end of the 1990s, when a body of evidence has been accumulated demonstrating vulnerability in the pre- and postanalytical phases.[2,3] The study by Abdollahi and co-workers confirms that more than 50% of errors are related to preanalytical steps, with 23.2% of errors in the intraanalytical and 11.7% in the postanalytical phase, respectively.[4] In addition, this study provides further evidence that the frequency of errors in inpatients is significantly higher than in outpatients due to several problems: Not always standard operating procedures (SOP) for test request, sample collection, handling, and transportation are followed by healthcare personnel who are not under the direct control of the laboratory; The complexity of some preanalytical steps (namely blood drawing) is higher for inpatients, due to age and disease issues; The trend toward consolidation and commoditization of laboratory services is decreasing the quality of communication between clinicians and laboratory professionals. The “take-home” message is the need to consensually develop and adopt SOP for safely performing patient identification and preparation, test requesting, sample collection and handling and that harmonization initiatives should be performed to improve procedures and processes at the laboratory–clinical interface. It seems likely that only a small proportion of laboratory errors results in actual patient harm and adverse events thanks to the several barriers and defensive layers present between the release of laboratory information, the decision-making process and, ultimately, the action on the patient. However, from a risk management viewpoint, even the great majority of laboratory errors with little direct impact on patient care provide important learning opportunities. In fact, any error, regardless of its apparent triviality, might indicate weaknesses in policies and procedures that may not lead to adverse events in their particular context, but might cause the patient harm in slightly different circumstances. An important step in the journey toward the reduction of the error rates in laboratory medicine is the implementation of a valuable quality system according to the International Standard ISO 15189:2012 and of reliable quality indicators (QIs) covering all steps of the intra- and extra-analytical phases of the total testing process (TTP).5 It has been demonstrated that performance and outcome measures improve the quality of patient care and, in particular, QIs represent valuable tools for quantifying the quality of selected aspects of care by comparing it against a defined criterion. The measurement and monitoring of QIs in laboratory medicine serve many purposes as they make possible to: Document the quality of the service provided; Improve performance and patient safety; Make comparison (benchmarking) over time between laboratories; Make judgments and set priorities (corrective actions to be performed); and Support accountability, quality improvement and accreditation. Recently a set of QIs has been consensually defined to allow clinical laboratories to measure and improve the quality of all steps of the TTP. The journey toward quality and patient safety continues.

Proposed standards for the design and conduct of a national clinical audit or quality improvement study

The purposes were to find and synthesize available literature on explicit or implicit standards for the design and conduct of a national activity that involves measuring and facilitating improvement of the quality of patient care, such as a national clinical audit or a quality improvement (QI) study, and to develop proposed standards for the design and conduct of the national activity. DATA SOURCES, SELECTION AND ANALYSIS: The literature was searched to identify key aspects of good practice in the conduct of national or international clinical audits, QI studies, performance or quality indicator measurements or equivalent national initiatives that have the purpose of driving improvement in the quality of care provided in a healthcare system. Key aspects of good practice in design or operation of these activities were abstracted from the literature, and organized logically into standard statements according to the stages in the design or conduct of such an activity. Thirty standards for the design and conduct of a national clinical audit or QI study were derived from the published literature. The standards are on structural, process and outcome aspects of any national activity that involves measuring and improving healthcare services. Most of the standards focus on measurement processes. It is hoped that these proposed standards for a national clinical audit or QI study will facilitate debate on how to assure the quality of these national activities. Activities that meet accepted standards may be more effective in influencing participating sites to achieve improvements in the quality of care.

Equity in Care: Picking Up the Pace

Eliminating disparities in healthcare is a goal of every American hospital. Despite our best efforts, we know that race, ethnicity, and language preference continue to affect the chance that patients will receive the care they need and the outcomes they deserve. For example, Hispanic adults with diabetes are far less likely to receive recommended preventive services and African American women are more likely to die after they are diagnosed with breast cancer than are their white counterparts. Because each hospital comprises and serves a unique community, increasing both the collection and the use of race, ethnicity, and language preference (REAL) data is an essential part of achieving equity in care for all Americans. With good data, hospitals can test the validity of their assumptions about the quality of care they provide. That care may be ideal, but without measurement, it is impossible to know. With careful measurement, every provider can document whether differences in outcomes and opportunities exist so it can improve the quality of care delivered by implementing customized approaches using evidence-based care. Supporting hospital efforts to eliminate disparities is one reason the American Hospital Association is a founding partner in the National Call to Action to Eliminate Health Care Disparities. With our partners, the American College of Healthcare Executives, Association of American Medical Colleges, Catholic Health Association of the United States, and National Association of Public Hospitals and Health Systems, we set out to achieve three interrelated goals: increase collection of REAL data, increase cultural competency training, and increase diversity in leadership. We have set up the Equity of Care website (http://www.equityofcare.org) to help hospitals, health systems, clinicians, and others improve the quality of care for each and every patient by sharing resources and best practices. We believe that most healthcare providers are moving in the right direction and that many are taking important steps to make care more equitable. But given the speed of change in our communities, we feel that this process must be accelerated, and information sharing is an important way to facilitate that. Healthcare providers must begin with a basic understanding of the population trends in the community they serve. American communities are undergoing huge demographic changes that may not immediately appear in the patient population of a given provider--but most surely will in the future. For the first time last year, most babies born in the United States were nonwhite. As health insurance coverage increases, each provider will be challenged to provide the best possible care to a unique patchwork of patient populations with different beliefs, lifestyles, family structures and support, and healthcare experiences. Planning for equitable care involves developing ongoing relationships with community organizations that can support providers' efforts to build cultural competency in delivering that care. Providers must anticipate community needs to, for example, ensure access to those with no or limited English proficiency or to develop patient education materials that consider differences in both language and culture. With careful measurement of REAL data, quality indicators, and patient outcomes--and using that information to constantly improve the quality of the care for each patient and for the community at large--providers will position themselves for future success. Measures of clinical quality and patient experience have increased significantly in recent years, and they are driving improvements across the board. But overall national quality measures cannot be readily broken down by race, ethnicity, and language preference. Recently, the Institute for Diversity in Health Management surveyed hospitals and found that 81 percent of hospitals collect REAL data, but only 18 percent used these data for quality interventions. …

Pain care quality and RN staffing characteristics among United States adult medical, surgical units

Previous research has shown that over 50% of adult medical-surgical patients were in pain during the past 24 hours. Nurses are the front-line caregivers in pain management yet there is not a national consensus measure of nurse-sensitive pain quality indicators. Hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a national nursing database, were recruited to participate in this research study. Pain care quality indicators were assessed in 326 U.S hospitals in 1611 nursing units; including 468 adult medical, surgical and medical-surgical combined units.

Letter to the Editor: Impacts of Organizational Context on Quality Improvement

To the Editor, In a recent article, Glasgow et al assessed the impacts of organizational context on quality improvement (QI). In their study of organizational characteristics of 100 hospitals participating in a national QI collaborative, they did not find any predictive associations with QI performance. Using a different approach, we conducted a study of 505 French hospitals that are subject to mandatory annual measurements of quality indicators in a national program aimed at promoting continuous quality improvement (CQI). This program is driven by the French Ministry of Health, the French Health Authority, and our research group (COMPAQ-HPST). From an analysis of the literature, we developed a theoretical frame that ranged potential factors of success for a CQI program along 2 axes. One concerned contextual factors (eg, staff stability, QI information), which covered the same organizational characteristics as described by Glasgow et al. The other included managerial factors (eg, managers use quality indicator results to define the hospi-tal's strategy, managers favor multiprofessional commitment when analyzing quality indicator results), which do not seem to have been considered in that article. Seventeen factors were identified and considered to be relevant by a panel of 22 health care professionals, using a consensus method. The relevance of these 17 factors was thereafter confirmed in 505 hospitals by assessing the correlation between the presence/absence of these factors and the results of 3 quality indicators (quality of patient medical records, pain assessment, and delay in sending information at patient discharge). A factorial analysis showed that the managerial axis included 6 factors and the contextual axis included 11. Cronbach α for the 2 axes were .78 and .82, respectively. A multivariate analysis showed a link between managerial score and the results of an indicator assessing the quality of patients' medical records (P = .02) and an indicator measuring the delay in sending information at patients' discharge (P = .03). We believe that managerial capacity is an important factor in the success of QI programs and should be analyzed more precisely.

Quality indicators in rheumatoid arthritis care: using measurement to promote quality improvement

Quality of care improvement has become a priority for decision-makers. Important variations in the quality and cost of care are being documented often without evidence of improved outcomes. Therapeutic advances...

A Rational Framework for Production Decision Making in Blood Establishments

Summary SAD_BaSe is a blood bank data analysis software, created to assist in the management of blood donations and the blood production chain in blood establishments. In particular, the system keeps track of several collection and production indicators, enables the definition of collection and production strategies, and the measurement of quality indicators required by the Quality Management System regulating the general operation of blood establishments.This paper describes the general scenario of blood establishments and its main requirements in terms of data management and analysis. It presents the architecture of SAD_BaSe and identifies its main contributions. Specifically, it brings forward the generation of customized reports driven by decision making needs and the use of data mining techniques in the analysis of donor suspensions and donation discards.

Updated 2012 Beers Criteria: What’s Noteworthy and Cautionary?

The Beers Criteria for potentially inappropriate medication use in older adults, originally published in 1991, have gone through several iterations.1 The initial publication focused exclusively on nursing home residents, providing a list of medications where the potential for harm exceeded the potential for beneficial effects. The criteria have arguably been influential in providing guidance for appropriateness of prescribing decisions in the elderly, especially for physicians and pharmacists practicing in long term care. In 1997 and again in 2003, the criteria were updated by a consensus panel of experts in geriatric pharmacotherapy who expanded the scope of the criteria and made it applicable for all adults aged 65 and older no matter where they reside and receive care.2,3 For more than a decade now, the Beers Criteria have been used as a clinical reference for informed decision making regarding prescribing in older adults. They have been used in several studies to predict health outcomes associated with potentially inappropriate medication (PIM) use in the elderly with variable andmixed results.4,5 The Beers Criteria also inform quality measures for several organizations and agencies, such as the National Committee for Quality Assurance, the Pharmacy Quality Alliance, the Centers for Medicare and Medicaid Services, and Medicare Part D. These bodies have relied on the criteria when developing quality measures addressing the pharmacological management of older adults.6 In 1999 and then again in 2006, the Centers for Medicare and Medicaid Services adopted some of the medications in the “Beers list” as quality indicator measures for assessing medication use in long term care facilities. The Beers Criteria have recently been revised by the American Geriatrics Society (AGS); this 2012 update,7 including several other tools and resources for public and professional use, are published on the AGS Web site.8 The 2012 Beers Criteria significantly improve on the previous methodology used in the past versions by using Institute of Medicine standards for clinical practice guidelines and a robust evidence-based grading system. The methodology and the literaturebased review are well characterized in the AGS publication.7 The structure and categorization of medications in tables remains essentially the same as in previous versions, with the exception of another table of medications to be used with caution. In essence, 53 medications or medication classes comprise the final updated criteria, and they are divided into 3 categories: PIMs and classes to avoid in

A rational framework for production decision making in blood establishments.

SAD_BaSe is a blood bank data analysis software, created to assist in the management of blood donations and the blood production chain in blood establishments. In particular, the system keeps track of several collection and production indicators, enables the definition of collection and production strategies, and the measurement of quality indicators required by the Quality Management System regulating the general operation of blood establishments. This paper describes the general scenario of blood establishments and its main requirements in terms of data management and analysis. It presents the architecture of SAD_BaSe and identifies its main contributions. Specifically, it brings forward the generation of customized reports driven by decision making needs and the use of data mining techniques in the analysis of donor suspensions and donation discards.

Influence of nearshore dynamics on the distribution of organic wastewater-associated chemicals in Lake Ontario determined using passive samplers

Passive samplers (SPMDs, semi-permeable membrane devices; POCIS, polar organic chemical integrative samplers) were deployed in Lake Ontario near Pickering, Ajax, and Port Hope, Ontario in 2008 and complemented with detailed water quality indicator and water current measurements. The intent was to examine the influences of source inputs and limnological features on the distribution and dilution patterns of several organic wastewater-associated chemicals (OWCs) in dynamic nearshore waters. Generally, concentrations ranged from 0.1 to 11ng/L for most pharmaceuticals and up to 25ng/L for gemfibrozil and 28ng/L for caffeine based on previously determined POCIS sampling rates. Musk (HHCB and AHTN) and triclosan (TCS) concentrations were estimated using laboratory-derived sampling rates as part of this study (4.3–7.9L/d) and ranged up to 10ng/L for musks and 1.5ng/L for TCS near Pickering–Ajax. Nitrate and conductivity maps indicated that alongshore currents were primary drivers of distribution and transport for tributary discharges and wastewater treatment plant (WWTP) effluents parallel to shore. Organic wastewater chemicals like HHCB, AHTN, TCS, gemfibrozil, and venlafaxine were greatest in the vicinity of the Pickering–Ajax WWTP and then dramatically declined. Ibuprofen, carbamazepine, and especially caffeine concentrations exhibited more uniform distributions both within and between the Pickering–Ajax and Port Hope study areas suggesting that transport via alongshore currents may contribute to a regional background of the relatively more persistent OWCs that may not be captured in onshore–offshore gradient studies.

Quality‐of‐care framework in urological cancers: where do we stand?

What's known on the subject? and What does the study add? Provision of high-quality care necessitates the identification and measurement of relevant quality indicators. Urological surgery currently does not have a validated quality-of-care framework to guide surgical quality improvement. This article aims to delineate quality of care processes, current status of quality indicators for major urological cancers as well as recommend a provisional framework for evaluation of quality for urological procedures. Growing demands for patient safety, lower cost and quality of care have resulted in several initiatives of quality measurement across urological surgery. Although candidate indicators have been proposed in various procedures, the field still lacks a valid quality framework. Better understanding of the interplay between patient selection, surgical expertise, preoperative-, intraoperative, postoperative processes and outcomes is needed. Consensus needs to be achieved in which validated structural, process and outcomes measures to employ, how this data should be collected, which agencies to share this data with and how to use this data to effect change in health policy. Compliance with quality framework needs to be continuously audited with its outcomes frequently benchmarked against international standards. Pursuit of quality improvement schemes require significant investment and need to be weighed against current budgetary constraints.

Subcarrier allocation for improvement of preamble sequence detection

A subcarrier allocation method is proposed for the improvement of the preamble sequence detection. Precise detection of the preamble sequence is crucial for identifying the base station. It is shown that the proposed method can substantially enhance the performance of the preamble sequence detection. Finally, the condition under which the proposed method can maintain the performance of the channel quality indicator measurement is investigated.

Von Leitlinien zur Qualitätssicherung

Clinical practice guidelines have been introduced to assist decision making at the bedside of individual patients. Guidelines are also increasingly regarded as being an indispensable part of professional quality systems. Guidelines are important tools to improve knowledge-management, processes and outcomes in healthcare. They aim to assist professional and patient decisions especially in those areas of healthcare where considerable variation or potential for improvement exist and they can provide a foundation for assessing and evaluating the quality and effectiveness of healthcare in terms of measuring processes and outcomes. Quality indicators or performance measures based on guideline recommendations are necessary to evaluate the usefulness of guidelines and the appropriateness of healthcare delivery. Guideline recommendations are the tools for healthcare professionals to develop strategies for quality improvement in case deviations from desired processes or outcomes are identified by the measurement of quality indicators.

Abstract A97: Quality assessment of colonoscopy reporting: Results from a statewide cancer screening program

Abstract Objectives: Appropriate documentation of the colonoscopy procedure is an important component of patient care and one measure of quality. However, direct evaluation of colonoscopy reporting has been minimal. The aim of this study was to assess the quality of colonoscopy reporting. Methods: We retrospectively collected data from 110 colonoscopy reports, where at least one polyp was noted. These reports were completed by 110 endoscopists from 2005-2006 through a statewide colorectal cancer screening program in Maryland, representing a variety of reporting formats from endoscopists throughout the state. We evaluated 25 key data elements recommended by the Standardized Colonoscopy Reporting and Data System (CO-RADS), including procedure indications, risk and comorbidity assessments, procedure technical descriptions, colonoscopy findings, and specimen retrieval and submission for pathology. Results: All 110 reports stated an indication for the endoscopy, 36% included patient's medical comorbidities, 73% documented the bowel preparation quality, and 82% documented specific cecal landmarks. For the 177 individual polyps identified, information on size and morphology was documented for 87% and 53%, respectively. For these key data elements, ambiguous descriptors were sometimes used. Conclusions: There was considerable variation among these colonoscopy reports. The absence of key data elements may impact the ability to make recommendations for recall intervals for colorectal cancer screening. Measurement of quality indicators in colonoscopy practice can identify areas for quality improvement. Citation Information: Cancer Prev Res 2010;3(12 Suppl):A97.

Perceived barriers to guidelines in peritoneal dialysis

Little is known regarding barriers to guideline adherence in the nephrology community. We set out to identify perceived barriers to evidence-based medicine (EBM) and measurement of continuous quality indicators (CQI) in an international cohort of peritoneal dialysis (PD) practitioners. Subscribers to an online nephrology education site (Nephrology Now) were invited to participate in an online survey. Nephrology Now is a non-profit, monthly mailing list that highlights clinically relevant articles in nephrology. Four hundred and seventy-five physicians supplying PD care participated in an online survey assessing their use of EBM and CQI in their PD practice. Ordinal logistic regression was utilized to determine relationships between baseline characteristics and EBM and CQI practices. The majority of physicians were nephrologists (89.7%), and 50.4% worked in an academic centre. Respondents were from the following geographic regions: 13.5% Canadian, 24% American, 23.8% European, 4.4% Australian, 5.3% South American, 10.7% African and 12.2% Asian. Adherence to PD clinical practice guidelines were generally strong; however, lower adherence was associated with countries with lower healthcare expenditure, not using personal digital assistant (PDA), the longer the physician had been practising and smaller (< 20 patients per centre) PD practice. International variation in guideline adherence may be influenced by a country's healthcare expenditure, physician's PDA use and experience, and size of PD practice which may impact future guideline development and implementation.

A Community Breast Center Report Card Determined by Participation in the National Quality Measures for Breast Centers Program

Measurement of quality indicators and peer comparison has been demonstrated to improve quality of care. The goal of this study was to determine whether a community breast center, in collaboration with the National Consortium of Breast Centers (NCBC), could voluntarily audit the quality of breast cancer care, confidentially transmit quality information to the NCBC, and receive peer performance comparisons. Quality indicator metrics from consecutive breast cancer patients undergoing care at a community interdisciplinary breast center were entered into a prospective database of quality measures that were defined by the NCBC. Retrospective review of patients from 2004 to 2006 was performed and subsequent quality indicator data was submitted electronically to the NCBC National Quality Measures for Breast Centers (NQMBC(TM) ) program. The percentage of new cancer diagnoses made by needle biopsy techniques was 94%, 95% and 96% from 2004 to 2006. Sentinel lymph node utilization in eligible patients was 93%, 96% and 91% from 2004 to 2006 and the immediate intraoperative pathologic frozen section false negative rate of the sentinel lymph node was 6.5%, 4.7% and 4%. Chart documentation of "patient participation in shared decision making for breast conserving therapy versus mastectomy" improved from 74% to 99% (p<0.05) from 2004 to 2006. Adjuvant systemic treatment for stage 2 breast cancer occurred in 76%, 89% and 77% of patients from 2004 to 2006. Neutropenia requiring hospital admission occurred in no patients in 2004 but in 4.8% and 2.9% in 2005 and 2006. The re-excision lumpectomy rates for stage 0, 1, 2, and 3 breast cancer patients from 2004 to 2006 was 14.2%, 22% and 24.8%. Quality indicator data was submitted to the NQMBC(TM) with successful confidential receipt of peer performance comparisons. Voluntary interdisciplinary institutional audits of breast cancer quality can be successfully submitted to the NQMBC(TM) with confidential peer performance comparison.

Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up.

BackgroundThe gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects.The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation.MethodsSix psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study.ResultsThe documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months.ConclusionsCompliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance.

Evaluation of β‐Glucosidase Activity as a Soil Quality Indicator for the Soil Management Assessment Framework

The Soil Management Assessment Framework (SMAF) was developed to assess conservation effects on soil, and uses multiple soil quality indicator measurements to compare soil functioning. Our objective was to develop a SMAF‐compatible scoring equation for soil β‐glucosidase (BG) activity using published data sets representing different soils and management. The resulting equation was an S‐shaped curve: y = a/[1 + bexp(−cx)], where x is the measured BG activity (mg p‐nitrophenol [PNP] released kg−1 soil h−1), a and b are constants, and c is a factor modified by soil classification, texture, and climate. Data from a study conducted near Mandan, ND were used to test the model for sensitivity to crop management systems. Soil organic C (SOC) content at the site measured 247 to 687 g kg−1, while BG activity ranged from 33 to 675 mg kg−1 h−1 Using SMAF, SOC indicator scores ranged from 0.25 to 0.73, while BG activity scores varied from 0.17 to 0.93. As the work progressed, it became apparent that when BG activity values were normalized to the SOC content, the resulting ratio could indicate C sequestration trends, with ratios of 10 to 17 g PNP kg−1 SOC h−1 reflective of systems in equilibrium. Ratios &gt;17 were mostly from recently altered management systems with SOC contents trending upward, while ratios &lt;10 were generally from soils that were expected to continue to lose soil C. The application of a sensitive C cycling enzyme activity such as BG should improve the SMAF soil quality assessments for soil functions where soil metabolic activity or C‐cycle enzyme activity play a role.

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

To improve colonoscopy quality, reports must include key quality indicators that can be monitored. To determine the quality of colonoscopy reports in diverse practice settings. 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. Prospective data collection from 2004 to 2006. 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. 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. Bias toward high rates of reporting because of the standard use of a computerized report generator. 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.