Used to detect changes or abnormalities in the large intestine and rectum, colonoscopy is widely used in the diagnosis and treatment of colon disease. The procedure involves inserting a long, flexible tube into the rectum. At the tip of the tube is a video camera that provides a view of the inside of the colon.
As the tube and camera pass through the colon, doctors can identify polyps or other abnormal tissue. They can remove tissue through the scope during the procedure or take tissue samples for biopsy.
Properly performed colonoscopies have minimal risk of adverse side effects and are the preferred method of colon evaluation in most adult patients. According to 2010 data, more than 3.3 million patients undergo outpatient colonoscopies each year.
To optimize the effectiveness of colonoscopy, patients must follow precise preparation measures, such as taking medication to clean the colon. When the bowel is not properly prepared, a complete examination may not be possible. In many cases, physicians must cancel the exam due to ineffective preparation, which amounts to a substantial waste of time and resources.
Along with patient preparation, colonoscopy success depends on the technical expertise of the performing physician. Not only must they conduct a thorough inspection to achieve high adenoma detection rates (ADRs), they must utilize optimal techniques to detect dysplasia in patients with inflammatory bowel disease.
According to multiple studies, gastroenterologists are more proficient than primary care physicians or surgeons at preventing colorectal cancer, likely due to their greater rate of completed colonoscopies and their higher ADR. To measure the quality of health care, facilities can consider quality indicators that are calculated as a proportion of interventions that achieve a specific goal.
Colonoscopy quality indicators fall into three categories. The first includes structural measures that can assess various factors within a broad healthcare environment. Examples include physician participation in a clinical database registry. The second category considers performance during delivery of care, such as biopsy sampling during a procedure for a patient with ulcerative colitis. The third category involves outcomes that measure the results of care. Examples include incidence of cancer prevention and reductions in numbers of perforation during colonoscopy.
The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy published their first colonoscopy quality indicators in 2006. A 2015 update evaluated extensive data to recommend changes to colonoscopy quality indicators.
First, the task force used a computerized search to identify relevant clinical studies, concentrating on parameters of endoscopic procedures performed in facilities with many variable factors. The task force updated quality indicators so that they may be developed into quality measures in the future.
For clarity, the task force divided quality indicators into three periods: before, during, and after the procedure. In each category, they identified key research questions to guide ongoing quality improvement efforts. Additionally, they recommended a subset of indicators depending on factors including the feasibility of measurement.
Endoscopists can use these quality indicators to measure their performance, moving from one indicator to the next as they meet or exceed recommended thresholds. Alternately, an employer might implement corrective measures for those who fail to meet these indicators, then re-measure them.
Correcting poor performance is the key goal of quality indicators. By ensuring all endoscopists are performing at a high level, medical facilities can improve patient care.
