Quality measures for colonoscopy: where should we be in 2015?

Area of Science:

• Gastroenterology
• Public Health
• Health Services Research

Background:

• Colonoscopy is a proven method for colorectal cancer (CRC) screening and prevention, contributing to a significant decline in CRC incidence and mortality in the USA.
• Current quality metrics for colonoscopy primarily focus on individual physician procedural success, often using data registries that may not directly correlate with patient health outcomes.
• The evolving healthcare landscape, driven by reform and value-based care models, necessitates a shift from individual performance metrics to a broader, population-level assessment of colonoscopy's value.

Purpose of the Study:

• To outline a new framework for evaluating the value of colonoscopy in CRC prevention within health systems.
• To propose a transition from individual physician-centric quality measures to population-level metrics that reflect overall health system performance and patient outcomes.
• To guide gastroenterologists and health systems in demonstrating their value and competitiveness in an accountable care environment.

Main Methods:

• The study proposes a shift to six key population-level metrics for health systems: screening rates, access to services, complication rates, patient experience, episode costs, and interval cancer rates.
• Individual gastroenterologist performance metrics (e.g., adenoma detection rate) will be used internally for network inclusion but will be secondary to population-level outcomes for external evaluation.
• The proposed approach leverages enterprise electronic medical records to streamline data population for external reporting and incentive programs.

Main Results:

• The current system of individual physician performance metrics and associated registries is becoming obsolete due to healthcare reform and the move towards population-level risk models.
• Health systems will be evaluated based on broader metrics reflecting the overall effectiveness and efficiency of colonoscopy services for CRC prevention.
• This shift will impact how provider networks are selected and how academic health centers compete with lower-cost providers.

Conclusions:

• A new paradigm for colonoscopy quality assessment is emerging, prioritizing population-level outcomes and value over individual procedural metrics.
• Health systems must adapt by focusing on comprehensive metrics that demonstrate the effectiveness of their CRC prevention strategies.
• This strategic shift is crucial for the survival and success of gastroenterology practices and health systems in the era of accountable care.