Improving Quality In Cancer Screening: The Excellence Report For Colonoscopy

描述（由申请人提供）：该倡议旨在评估和提高门诊护理环境中筛查和诊断结肠镜检查的质量。利用临床结果研究倡议（CORI）联盟和国家内窥镜数据库（NED），我们将开发和测试卓越报告，这是胃肠道（GI）内窥镜检查的质量报告卡，重点关注国家认可的结肠镜检查质量过程措施。在制定卓越报告后，我们将使用定性和定量方法对其进行评估。采用集群随机试验设计，在门诊护理中心或办公室工作的CORI附属临床医生将收到每月的质量测量报告，以及与其他CORI临床医生和国家基准的比较。对质量测量数据报告和对质量建议的遵守的影响将与停止报告后变化的持久性一起进行测量。同时，将对接受卓越报告的具有代表性的临床医生样本进行实地观察和访谈。根据这些观察和访谈，将创建一项调查，并对所有参与的临床医生进行管理。我们将了解临床医生对所提供数据的可靠性和有效性的看法，他们对质量倡议的接受程度，我们将寻找对工作流程的影响以及卓越报告的任何意想不到的后果。在此开发和评估活动的同时，该计划将支持GI报告软件供应商、成像系统供应商和GI病理实验室组成的工作组，以及GI专业协会，共同开发一个可持续的、基于标准的架构，使卓越报告能够扩展到CORI之外。

DESCRIPTION (provided by the applicant): This initiative is designed to evaluate and improve the quality of screening and diagnostic colonoscopies in ambulatory care settings. Using the Clinical Outcomes Research Initiative (CORI) consortium and the National Endoscopic Database (NED) we will develop and test the Excellence Report, a quality report card for gastrointestinal (GI) endoscopy, focusing on nationally-recognized quality process measures for colonoscopy. After development of the Excellence Report, we will evaluate it using both qualitative and quantitative methodologies. Using a clustered randomized trial design, CORI-affiliated clinicians working in ambulatory care centers or offices will receive monthly reports of their quality measures along with comparisons to other CORI clinicians and to national benchmarks. The effect both on reporting of quality measures data and on adherence to the quality recommendations will be measured along with the durability of changes upon ceasing the reports. Concurrently, field observations and interviews will be performed with a representative sample of clinicians who are receiving the Excellence Report. Based on these observations and interviews, a survey will be created and administered to all participating clinicians. We will learn about the perceptions of the clinicians of reliability and validity of the data that are presented, their acceptance of the quality initiative, and we will look for effects on workflow and for any unintended consequences of the Excellence Report. Concurrent with this development and evaluation activity, this initiative will support a workgroup of GI reporting software vendors, imaging system vendors and GI pathology laboratories along with the GI specialty societies on development of a sustainable and standards based architecture that will allow the Excellence Report to expand beyond CORI.