Researchers Discover Disparity Among Colonoscopy Quality

Qualities in colonoscopies can be assessed using a new tool, which can track hospital follow-ups in outpatient facilities, according to findings published in Gastroenterology.

Researchers from Yale University sampled patients from the 2010 Medical outpatient colonoscopy claims to examine outpatient facilities by estimating rates of unplanned hospital visits within seven days of the patients’ colonoscopies.

The 20% of patients studied (of a total of 331,880 across 8,140 facilities) were 65 years or older. Unplanned hospital visits were defined as emergency department visits, observation stays and inpatient admissions within seven days of their colonoscopies.

About 16 per 1,000 outpatient colonoscopies resulted in unplanned hospital visits within a week after the procedure among Medicare beneficiaries, the researchers reported. However, the rates significantly varied across outpatient facilities, which suggested there was a disparity among the quality of care.

The most common causes of the unplanned hospital visits were hemorrhage, abdominal pain, and perforation. Among 15 variables that were independently associated with hospital visits were a history of fluid and electrolyte imbalances, psychiatric disorders and — in the absence of prior arrhythmia – age increasing after 65 years.

“This measure is a potentially useful tool for advancing patient centered care,” research scientist Elizabeth Drye, MD, MS explained in a press release. “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.”

The researchers reported the facility risk standardized unplanned hospital visits determined using the Healthcare Costs and Utilization Project data demonstrated significant flexibility: the median was 12.3 per 1,000; the 5^th to 95^th percentile was 10.2 per 1,000.

The median risk standardized unplanned hospital visits were similar among ambulatory surgery centers and hospital outpatient departments, each measuring about 10 per 1,000. The ranges were between 16.1 per 1,000 in the Northeast region of the United States and 17.2 per 1,000 in the Midwest.

“Outpatient colonoscopy quality shows important variation in quality among outpatient facilities,” the researchers summarized. “This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality improvement efforts.”