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A Nationwide Survey and Needs Assessment of Colonoscopy Quality Assurance Programs

Variability exists in quality documentation, measurement, and reporting practices of colonoscopy screening in VA facilities, and most do not have formal performance improvement plans.
Federal Practitioner. 2018 March;35(3)a:26-32
March 6, 2018|Federal Practitioner
Andrew J. Gawron, MD, PhD, MS;Phillip Lawrence, PharmD;Morgan M. Millar, PhD;Jason A. Dominitz, MD;Samir Gupta, MD;Mary Whooley, MD;Tonya Kaltenbach, MD
Author and Disclosure Information

Author Affiliations
Dr. Gawron is a Gastroenterologist at the Salt Lake City Specialty Care Center of Innovation at the VA Salt Lake City Health Care System and Assistant Professor at the University of Utah. Dr. Lawrence is an Assistant Professor at Roseman University of Health Sciences in Utah. Dr. Millar is a Research Instructor in the Division of Epidemiology, University of Utah. Dr. Dominitz is the National Program Director for Gastroenterology at the VA and Professor of Medicine at the University of Washington in Seattle. Dr. Gupta is a Gastroenterologist at the San Diego VA Health Care System and Associate Professor at the University of California, San Diego. Dr. Whooley is a Primary Care Physician at the San Francisco VA Health Care System and Professor at University of California, San Francisco. Dr. Kaltenbach is a Gastroenterologist at the San Francisco VA Health Care System and Associate Professor at the University of California, San Francisco.
Correspondence: Dr. Gawron (andrew. gawron@va.gov)

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Limitations

This survey was a cross-section of VA sites’ points of contact regarding colonoscopy quality assurance programs, so the results are descriptive in nature. However, the instrument was carefully developed, using both subject matter and survey method expertise. The questionnaire also was refined through pretesting prior to data collection. The initial contact list was found to have errors, and the list had to be updated after launching the survey. Updated information for most of the contacts was available.

Another limitation was the inability to survey nongastroenterologist-run endoscopy centers, because many centers use surgeons or other nongastroenterology providers. The authors speculate that quality monitoring may be less likely to be present at these facilities as they may not be aware of the gastroenterology professional society recommendations. The authors did not require or insist that all questions be answered, so some data were missing from sites. However, 93.7% of respondents completed the entire survey.

Conclusion

The authors have described the status of colonoscopy quality assurance programs across the VA health care system. Many sites are making robust efforts to measure and report quality especially of process measures. However, there are significant time and manual workforce efforts required, and this work is likely associated with the variability in programs. Importantly, ADR, which is the quality metric that has been most strongly associated with risk of colon cancer mortality, is not being measured by 38% of sites.

These results reinforce a critical need for a centralized, automated quality reporting infrastructure to standardize colonoscopy quality reporting, reduce workload, and ensure veterans receive high-quality colonoscopy.

Acknowledgments
The authors acknowledge the support and feedback of the National Gastroenterology Program Field Advisory Committee for survey development and testing. The authors coordinated the survey through the Salt Lake City Specialty Care Center of Innovation in partnership with the National Gastroenterology Program Office and the Quality Enhancement Research Initiative: Quality Enhancement Research Initiative, Measurement Science Program, QUE15-283. The work also was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award UL1TR001067 and Merit Review Award 1 I01 HX001574-01A1 from the United States Department of Veterans Affairs Health Services Research & Development Service of the VA Office of Research and Development.

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