Improving Quality in Cancer Screening: The Excellence Report for Colonoscopy

This project was designed to evaluate and improve the quality of screening and diagnostic colonoscopies in ambulatory care settings. It was implemented within the Clinical Outcomes Research Initiative (CORI) national consortium. Defined quality measures for colonoscopy were used in individual quality report cards with 15 measures created and made available to participating endoscopists. Quantitative and qualitative studies were performed on the effect of these reports.

The objectives of the project were as follows:

1. To create a quality report card, the "Excellence Report", from this clinical data demonstrating individual performance on evidence-based quality measures for colonoscopy, including comparisons with other CORI practitioners and nationally published benchmarks.
2. To determine if providing this quality report card as monthly feedback to endoscopists in ambulatory settings would result in quality improvement as evidenced by improved documentation of and adherence to the quality measures.
3. To evaluate, using qualitative research techniques, the perceptions by participating endoscopists of this feedback and to search for both unintended consequences and alterations in workflow resulting from the intervention.
4. To explore and contribute to emerging interoperability standards for quality measurement and to help bring these standards to the Gastrointestinal community.

Data analysis is still pending on the quantitative study, but it is the expectation that no change in compliance with the quality measures will be found. The qualitative study revealed that endoscopists are not only aware of quality measurement recommendations but have changed their practice to meet those recommendations. Most endoscopists felt that they were performing within guidelines and would be willing to share their quality reports, although their distrust of payors was clear. Implementation of the chosen quality measures proved difficult for several reasons, including the difficulty of finding and validating correctness of data from complex clinical systems and the complexity of quality criteria, especially for determining exclusions. Implementation was also limited by the difficulty of retrieving pathology results, whether in narrative or discrete data form, and even in obtaining access to images of pathology result reports.

The project team concluded that clinicians will not need encouragement to participate in quality measurement programs, which are seen as inevitable and even desirable, but that programs will need to emphasize quality measures that are relevant to clinical care and be certain about the accuracy of the information presented.