Researchers use new method to assess quality of colonoscopies performed in outpatient facilities

Colonoscopies are now a routine preventive diagnostic test for millions of Americans each year. While rates are low, complications like perforation, bleeding, and anesthesia-related heart failure can occur. Yale School of Medicine researchers have now developed a quality measure that uses follow-up hospital visits to track the variation in colonoscopy quality among outpatient facilities.

Dr. Elizabeth Drye, research scientist in pediatrics and director of quality measurement programs at the Yale/Yale-New Hospital Center for Outcomes Research and Evaluation, and her colleagues, recently published their findings in the journal Gastroenterology.

The team tracked Medicare fee-for-service patients age 65 and older who were undergoing colonoscopy. They developed a quality measure that profiles facility performance in outpatient colonoscopy by estimating risk rates for unplanned hospital visits in the seven days following colonoscopy among Medicare beneficiaries using claims data.

The team found that 16.3 per 1,000 outpatient colonoscopies among Medicare beneficiaries result in unplanned hospital visits following the procedure. These rates vary substantially across outpatient facilities, suggesting a variation in quality.

Drye said that many of the leading causes of hospital visits such as bleeding, abdominal pain, and perforation are potentially preventable, yet currently these events are often not visible to colonoscopy providers or patients.

"This measure is a potentially useful tool for advancing patient-centered care," said Drye. "Publicly reporting facility quality will inform a patient's choice and make the full range of patient outcomes visible to providers, thereby addressing a critical information and quality measure gap. The Centers for Medicare & Medicaid Services (CMS) will start publicly reporting the measure scores for facilities in the coming year."