Colonoscopy quality and outcomes in clinical practice

临床实践中结肠镜检查的质量和结果

• 批准号: 7617731
• 负责人: CYNTHIA W KO
• 金额: $ 27.94万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7617731
• 关键词: Algorithms; Ambulatory Care; Biopsy; Cancer Detection; Caring; Cecum; Characteristics; Clinical; Code; Colon; Colonic Polyps; Colonoscopy; Colorectal Cancer; Complex; Complication; Congresses; Data; Databases; Detection; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Effectiveness; Ensure; Gastroenterology; Gastrointestinal Diseases; General Population; Goals; Health Personnel; Health Policy; Healthcare; Hospitals; Individual; Inpatients; Link; Malignant Neoplasms; Measurement; Measures; Medical Records; Medicare; Medicare claim; Methods; Outcome; Patients; Pattern; Performance; Physicians; Polypectomy; Polyps; Predictive Value; Procedures; Provider; Quality Indicator; Quality of Care; Reporting; Screening procedure; Sensitivity and Specificity; Statutes and Laws; Symptoms; Testing; Training; United States; United States Centers for Medicare and Medicaid Services; Validation; base; clinical practice; colorectal cancer screening; cost; experience; health care quality; programs; tool

DESCRIPTION (provided by applicant): Colonoscopy is recommended for colorectal cancer screening as well as the diagnosis and treatment of various gastrointestinal diseases. It is one of the most common ambulatory care procedures, with estimates of over 14 million procedures in 20002. It is also technically complex, and colonoscopy quality and outcomes may be quite variable. Given its widespread application and high costs, understanding the quality and outcomes of colonoscopy as applied in routine clinical practice is vital. Use of administrative data to measure health care quality is attractive, but the validity of administrative data for routine measures that might indicate quality is not established. This proposal provides important methodological first steps towards using administrative data to measure colonoscopy quality. In our first specific aim, we will obtain colonoscopy reports from medical records of a diverse group of providers to use to determine the accuracy of administrative claims for colonoscopy. These reports will be linked to colonoscopy claims in the Medicare claims database. We will examine the sensitivity, specificity, positive predictive value, and negative predictive value of the claims for a variety of important colonoscopy quality indicators, including incomplete colonoscopy, detection rates for colon polyps or cancers, and use of biopsy or polypectomy. Developing an algorithm to determine colonoscopy indication from administrative data is another important methological step towards using such data in quality measurement. For example, the rate of polyp or cancer detection may be different in patients undergoing this procedure for colorectal cancer screening, as compared to patients who clinical signs or symptoms. The ability to examine quality measures in administrative data is therefore dependent upon understanding colonoscopy outcomes. In our second and third specific aims, we will develop and test an algorithm to determine colonoscopy indications from claims data. In an initial, training subset of our database, we will examine the diagnostic and procedure codes associated with the colonoscopy claim as well as codes from prior claims to find individual codes or patterns of coding that predict colonoscopy outcome. The various algorithms we develop will be tested in a second, validation subset of our database to find the algorithm with optimal performance characteristics.

描述（申请人提供）：结肠镜检查被推荐用于结直肠癌筛查以及各种胃肠道疾病的诊断和治疗。它是最常见的门诊护理程序之一，2000年估计有超过1400万例。它在技术上也很复杂，结肠镜检查的质量和结果可能差异很大。鉴于其广泛的应用和高成本，了解结肠镜检查在常规临床实践中的质量和结果至关重要。使用行政数据来衡量医疗质量是有吸引力的，但行政数据的有效性，可能表明质量的常规措施尚未建立。该提案为使用管理数据来衡量结肠镜检查质量提供了重要的方法学第一步。在我们的第一个具体目标，我们将获得结肠镜检查报告的医疗记录的一组不同的供应商使用，以确定结肠镜检查的行政索赔的准确性。这些报告将链接到医疗保险索赔数据库中的结肠镜检查索赔。我们将检查各种重要结肠镜检查质量指标的敏感性，特异性，阳性预测值和阴性预测值，包括不完全结肠镜检查，结肠息肉或癌症的检出率，以及活检或息肉切除术的使用。开发一种从管理数据中确定结肠镜检查指征的算法是使用此类数据进行质量测量的另一个重要方法学步骤。例如，与具有临床体征或症状的患者相比，在经历用于结肠直肠癌筛查的该程序的患者中息肉或癌症检测率可能不同。因此，在管理数据中检查质量指标的能力取决于对结肠镜检查结果的理解。在我们的第二个和第三个具体目标中，我们将开发和测试一种算法，以根据索赔数据确定结肠镜检查适应症。在我们数据库的初始训练子集中，我们将检查与结肠镜检查声明相关的诊断和程序代码以及先前声明的代码，以找到预测结肠镜检查结果的单个代码或编码模式。我们开发的各种算法将在我们数据库的第二个验证子集中进行测试，以找到具有最佳性能特征的算法。