Quality Colonoscopy, An Issue of Gastrointestinal Endoscopy Clinics

John I. Allen

Description

Dr. Allen’s issue focuses on how gastroenterologists can maximize the “value of colonoscopy – where value is defined as quality/cost. Clinical issues are covered, like sedation issues, complications of colonoscopy, and infection risk, but the majority of the articles deal with the discussions that surround quality colonoscopy—articles like: Risk Management and Legal Issues for Colonoscopy; Cost effectiveness of Colonoscopy in Prevention of Colon Cancer; Efficacy and Effectiveness of Colonoscopy: How Do We Bridge the Gap?; Current State of Colonoscopy Performance Measures; Use of Databases and Registries to Enhance Quality; and Maximizing the Value of Colonoscopy in Community, to name a few. In preparation of the changing landscape of healthcare, this issue will be an important one for all practicing gastroenterologists.

Sujets

• Gastroenterology
• Médecine
• Medical

Informations

• Publié par: Saunders
• Date de parution: 28 octobre 2010
• Nombre de lectures: 0
• EAN13: 9781455700318
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Gastrointestinal Endoscopy Clinics of North America , Vol. 20, No. 4, October 2010
ISSN: 1052-5157
doi: 10.1016/S1052-5157(10)00107-8

Contributors
Gastrointestinal Endoscopy Clinics of North America
Colonoscopy Quality
John I. Allen
Minnesota Gastroenterology PA, PO Box 14909, Minneapolis, MN 55414, USA
ISSN  1052-5157
Volume 20 • Number 4 • October 2010

Contents
Cover
Contributors
Forthcoming Issues
Foreword
Preface
Risk Management and Legal Issues for Colonoscopy
Reducing Infection Risk in Colonoscopy
Sedation Issues in Quality Colonoscopy
Management of High-Risk Colonoscopy Patients
Maximizing the Value of the Endoscopist–Pathologist Partnership in the Management of Colorectal Polyps and Carcinoma
Complications of Colonoscopy: Magnitude and Management
Efficacy and Effectiveness of Colonoscopy: How Do We Bridge the Gap?
Colonoscopy Reports and Current State of Performance Measures
Advanced Systems to Assess Colonoscopy
The Use of Databases and Registries to Enhance Colonoscopy Quality
Defining an Episode of Care for Colonoscopy: Work of the High Value Health Care Project Characterizing Episodes and Costs of Care
Cost-effectiveness of Colonoscopy
Maximizing the Value of Colonoscopy in Community Practice
Index
Gastrointestinal Endoscopy Clinics of North America , Vol. 20, No. 4, October 2010
ISSN: 1052-5157
doi: 10.1016/S1052-5157(10)00109-1

Forthcoming Issues
Gastrointestinal Endoscopy Clinics of North America , Vol. 20, No. 4, October 2010
ISSN: 1052-5157
doi: 10.1016/j.giec.2010.07.013

Foreword

Charles J. Lightdale, MD
Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, Room 812, New York, NY 10032, USA
E-mail address: [e-mail]


Charles J. Lightdale, MD Consulting Editor
Colonoscopy for screening, surveillance, and prevention of colorectal cancer is one of the great success stories of modern gastrointestinal endoscopy. In the United States, at least in part because of widespread utilization of colonoscopy, colon cancer incidence and mortality are decreasing. Yet the mass application of colonoscopy in populations at risk has not unexpectedly focused intense scrutiny on colonoscopy practice. For most clinical gastroenterologists, colonoscopy examinations for cancer prevention are a central part of their practice. The electronic medical record and powerful computers will provide rivers of data for analysis of what they actually do and accomplish. How to achieve the highest quality in these procedures at a cost compatible with national health priorities has become a paramount issue.
Probably no one in the country knows more about the critical questions involved with colon cancer screening and colonoscopy practice than John I. Allen, MD, MBA, who is Guest Editor for this issue of Gastrointestinal Endoscopy Clinics of North America . Dr Allen is first and foremost not an ivory tower analyst, but rather a practicing gastroenterologist with Minnesota Gastroenterology, St Paul, where he also serves as medical director for quality. Dr Allen, who has extraordinary insights into the practice of gastroenterology in the United States, also holds an appointment at the University of Minnesota, Minneapolis, and has major roles in the American Gastroenterological Association, most recently as chair of the AGA executive management board developing and overseeing a national outcomes registry for gastroenterologists.
When I suggested to Dr Allen that he should be Guest Editor for an issue of Gastrointestinal Endoscopy Clinics of North America on the “quality” of colonoscopy, he countered that he preferred to broaden the subject to encompass the “value” of colonoscopy. I accepted immediately, but quickly checked my Oxford English Dictionary for the word “value.” The most fitting definition seemed to be: “the relative status of a thing…according to its real worth.” How to provide ongoing high value in colonoscopy screening will be a primary concern of practicing gastroenterologists for the foreseeable future. Dr Allen has selected topics authored by the greatest experts and thought leaders in the area. This volume represents an essential guide for practicing gastroenterologists and is a compelling read for all.
Gastrointestinal Endoscopy Clinics of North America , Vol. 20, No. 4, October 2010
ISSN: 1052-5157
doi: 10.1016/j.giec.2010.07.010

Preface

John I. Allen, MD, MBA, AGAF
Minnesota Gastroenterology PA, PO Box 14909, Minneapolis, MN 55414, USA
University of Minnesota School of Medicine, 420 Delaware Street, SE, Minneapolis, MN 55455, USA
E-mail address: [e-mail]


John I. Allen, MD, MBA, AGAF Guest Editor
A high-quality colonoscopy exam performed by an experienced endoscopist is safe and comfortable and offers patients a high value for their health care dollar. Colonoscopy helps provide accurate assessment of an individual’s colorectal cancer (CRC) risk, allows the endoscopist to diagnose prevalent neoplasia, and reduces risk for future CRC when physicians find and remove precancerous polyps. This nation’s infrastructure for CRC screening has grown substantially over the last decade and real gains in cancer prevention and survival have been achieved based in part on the effectiveness of colonoscopy. In 2010, colonoscopy is the most widely used CRC screening and surveillance intervention, and approximately 12 million exams are performed annually in the United States. The cost for these exams exceeds $14 billion. It is in the best interest of this nation to maximize the health care value of colonoscopy.
Of all the screening tests endorsed by the United States Preventative Services Task Force, colonoscopy is the most expensive, most invasive, and most dangerous. It also ranks among the most cost effective and clinically effective screening tests for adults. The clinical effectiveness of colonoscopy as a cancer prevention modality relates directly to the quality of the exam. Cost effectiveness of colonoscopy relates to both quality and cost. If quality is substandard or the cost is high, then the health care value is diminished.
The “value” of colonoscopy (or any medical intervention) is defined as Quality/Cost, where quality reflects the Institute of Medicine’s (IOM) “Six Aims.” The IOM states that medical care should be safe, timely, efficient, effective, equitable, and patient-centered. Cost refers to both the individual cost of an intervention and the overall cost to a population of their medical care. Donald Berwick, MD, past President of the Institute for Healthcare Improvement and now the Director of the Centers for Medicare and Medicaid, has written about the “Triple Aim.” Health care should enhance the experience of the individual, increase the health of the nation, and reduce the overall cost of care.
These concepts are important for the endoscopist to understand since there are serious questions concerning results of colonoscopy when used to screen for and prevent CRC. There have been egregious breaks in safety protocols related to both endoscope cleaning and sedation that have resulted in infection transmission from patient to patient. Variations in the cost of colonoscopy are well documented and the rate of CRC diagnosed within 3 years of a “normal” colonoscopy remains a concern.
In this issue, we have tapped the experience and thoughts of many leaders in the field of colonoscopy and CRC prevention. The overall focus of this issue is how we as individual endoscopists, the health care system, and the nation can maximize the health care value of colonoscopy. In the first six articles, the focus is on the individual experience of colonoscopy. Topics include risk management, infection control, sedation issues, management of high-risk individuals, pathology considerations, and procedure complications. The next three articles deal with how we might improve colonoscopy with adequate documentation, performance measures, and advanced imaging and computer analytic technologies. Three articles focus on a national perspective by discussing use of large databases, innovative payment methodologies, and cost-effectiveness analysis. The final article summarizes efforts to maximize the value of colonoscopy in the community setting.
I wish to thank the authors for their valuable contributions and generous donation of their time and intellect. Special thanks goes to Dr Charles Lightdale for seeing the need for this issue and offering me the opportunity to edit. Finally, Kerry Holland and her staff at Elsevier deserve heartfelt thanks for overseeing editing and publication.
Gastrointestinal Endoscopy Clinics of North America , Vol. 20, No. 4, October 2010
ISSN: 1052-5157
doi: 10.1016/j.giec.2010.07.002

Risk Management and Legal Issues for Colonoscopy

Kayla A. Feld, AB a , b , Andrew D. Feld, MD, JD, AGAF c , d , e , *
a Harvard University, Massachusetts Hall Cambridge, MA 02138, USA
b Tulane University School of Law, 6329 Freret Street, New Orleans, LA 70118, USA
c University of Washington, Division of Gastroenterology, 1959 NE Pacific Street, PO Box 356424, Seattle, WA 98195-6424, USA
d Rockwood Clinic, Division of Gastroenterology, 400 East 5th Avenue, Spokane, WA 99202, USA
e Group Health Cooperative, Division of Gastroenterology, 125 16th Avenue East, CSB-2, Seattle, WA 98112, USA
* Corresponding author. Rockwood Clinic, Division of Gastroenterology, 400 East 5th Avenue, Spokane, WA 99202.
E-mail address: [e-mail]

Abstract
This article reviews potential risk areas and legal issues in quality and colonoscopy. These include issues about open access colonoscopy, informed consent for colonoscopy, missed colorectal cancer, problems related to anticoagulation or its withdrawal for colonoscopy, procedural problems with sedation, failure to follow up appropriately, and failure to identify and warn of high genetic risk.

Keywords
• Colonoscopy