Development and validation of a new ICD-10-based screening colonoscopy overuse measure in a large integrated healthcare system: a retrospective observational study.
Development and validation of a new ICD-10-based screening colonoscopy overuse measure in a large integrated healthcare system: a retrospective observational study.
复制标题
DOI：
10.1136/bmjqs-2021-014236
复制
发表时间：
2023-07
影响因子：
5.4
通讯作者：
Saini, Sameer D.
中科院分区：
文献类型：
--
作者：
Adams, Megan A.;Kerr, Eve A.;Dominitz, Jason A.;Gao, Yuqing;Yankey, Nicholas;May, Folasade P.;Mafi, John;Saini, Sameer D.
低价值的结肠镜检查是一种浪费，对患者有潜在的危害。减少低价值结肠镜检查可预防手术并发症，节省患者时间，减少患者不适，并可通过减少手术需求来改善通路。本研究的目的是使用ICD-10代码开发和验证筛查结肠镜过度使用的电子测量，然后应用该测量来估计设施水平的过度使用，以针对质量改进措施，以减少大型综合医疗保健系统中的过度使用。2017年，在119家退伍军人健康管理局（VHA）内窥镜检查机构接受筛查结肠镜检查的美国退伍军人的回顾性国家观察性研究。由专家指定筛查结肠镜检查过度使用的指标，并对指标分子和分母进行电子近似（“电子指标”）。然后通过手动记录审查验证电子测量（n=511）。可靠性统计（n=100）与电子测量的诊断测试特征一起计算沿着。然后将该措施应用于估计所有合格患者过度使用的总体比率和过度使用的设施水平变化。电子测量具有高特异性（99%）和中等敏感性（46%）。调整后的PPV和NPV分别为33%和95%。评分员间可靠性测试显示评分员之间接近完美的协议（k=0.81）。2017年在VHA进行了269，572次结肠镜检查（88，143次归类为筛选程序）。将该措施应用于这88，143次筛查结肠镜检查，24.5%被确定为潜在的过度使用。设施水平过度使用的中位数为22.5%，各设施之间存在显著差异（IQR 19.1%-27.0%）。与先前基于ICD-9的测量相比，基于ICD-10的筛查结肠镜过度使用的电子测量具有高特异性和提高的灵敏度。尽管人们越来越关注减少低价值护理和改善可及性，但2017年四分之一的VHA筛查结肠镜检查被确定为潜在的低价值程序，具有显著的设施水平差异。
Low-value use of screening colonoscopy is wasteful and potentially harmful to patients. Decreasing low-value colonoscopy prevents procedural complications, saves patient time and reduces patient discomfort, and can improve access by reducing procedural demand. The objective of this study was to develop and validate an electronic measure of screening colonoscopy overuse using ICD-10 codes and then apply this measure to estimate facility-level overuse to target quality improvement initiatives to reduce overuse in a large integrated healthcare system. Retrospective national observational study of US Veterans undergoing screening colonoscopy at 119 Veterans Health Administration (VHA) endoscopy facilities in 2017. A measure of screening colonoscopy overuse was specified by an expert workgroup, and electronic approximation of the measure numerator and denominator was performed (“electronic measure”). The electronic measure was then validated via manual record review (n=511). Reliability statistics (n=100) were calculated along with diagnostic test characteristics of the electronic measure. The measure was then applied to estimate overall rates of overuse and facility-level variation in overuse among all eligible patients. The electronic measure had high specificity (99%) and moderate sensitivity (46%). Adjusted PPV and NPV were 33% and 95%, respectively. Inter-rater reliability testing revealed near perfect agreement between raters (k=0.81). 269,572 colonoscopies were performed in VHA in 2017 (88,143 classified as screening procedures). Applying the measure to these 88,143 screening colonoscopies, 24.5% were identified as potential overuse. Median facility-level overuse was 22.5%, with substantial variability across facilities (IQR 19.1%–27.0%). An ICD-10-based electronic measure of screening colonoscopy overuse has high specificity and improved sensitivity compared to a previous ICD-9-based measure. Despite increased focus on reducing low-value care and improving access, a quarter of VHA screening colonoscopies in 2017 were identified as potential low-value procedures, with substantial facility-level variability.
登录
查看更多内容
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
影响因子：
3.1
作者：
Fisher, Deborah A.;Grubber, Janet M.;Coffman, Cynthia J.
通讯作者：
Coffman, Cynthia J.
影响因子：
39
作者：
Ganguli I;Morden NE;Yang CW;Crawford M;Colla CH
通讯作者：
Colla CH
影响因子：
39
作者：
Sheffield, Kristin M.;Han, Yimei;Goodwin, James S.
通讯作者：
Goodwin, James S.