• AAAHC Institute for Quality Improvement. Procedure specific colonoscopy survey [Colonoscopy CPT-45378-45385]. Wilmette (IL): AAAHC Institute for Quality Improvement; 2003. 2 p.

Does not apply to this measure

This measure assesses the percentage of patients who developed one or more intra-procedure colonoscopy complications.

Part of the rationale for studying colonoscopy (Current Procedure Terminology [CPT] codes 45378-45385) is that it is the second most frequently performed procedure in U.S. ambulatory care, with more than 1.1 million of the almost 1.4 million colonoscopies reported as occurring in the ambulatory setting in 1996. Additionally, colonoscopies are a means of detecting colorectal cancer and of preventing deaths from this third leading cancer (not including skin cancer) for American men and women. Further, although there will continue to be disagreement about what the "best" test is for detecting colorectal cancer, colonoscopy allows the endoscopist to remove lesions and polyps at the time of the procedure (unlike a barium enema) and may detect cancer in a substantial proportion (maybe 45%) of people whose colon cancer would otherwise go undetected (as opposed to sigmoidoscopy). Colonoscopy is not without cost; direct costs, risks to patients (such as bowel perforation), potential patient discomfort, and other related costs must be considered in a cost-benefit analysis. Many national organizations have clinical practice guidelines that recommend colorectal cancer screening for select populations and several refer to the use of colonoscopy as the screening process in certain patient populations.

Colorectal cancer; colonoscopy; intra-procedure complications (arrhythmia, bleeding requiring treatment/intervention, extended recovery, hospital transfer, hypotension, hypoxia, noted perforation[s], respiratory arrest)

Patients undergoing colonoscopy procedure (Current Procedure Terminology [CPT] codes 45378-45385) at the ambulatory health care organization

Number of patients from the denominator who developed one or more intra-procedure complications*

*Complications include arrhythmia, bleeding requiring treatment/intervention, extended recovery, hospital transfer, hypotension, hypoxia, noted perforation(s), respiratory arrest.

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Use of this measure to improve performance

• AAAHC Institute for Quality Improvement. Colonoscopy 2003 study. Wilmette (IL): Accreditation Association for Ambulatory Health Care, Inc. (AAAHC); 2003. 21 p.

Current routine use

Internal quality improvement

Ambulatory Care

Advanced Practice Nurses
Nurses
Physicians

Single Health Care Delivery Organizations

Unspecified

Either male or female

Unspecified

Colonoscopy is the second most frequently performed procedure in U.S. ambulatory care, with more than 1.1 million of the almost 1.4 million colonoscopies reported in the ambulatory setting in 1996.

Because colonoscopy is generally recommended for those over 50 and those with higher risk or history of cancer, elderly and therefore elderly frail will be disproportionately represented.

Colorectal cancer is the fourth most common cancer in the United States and the second leading cause of cancer death. A person at age 50 has about a 5 percent lifetime risk of being diagnosed with colorectal cancer and a 2.5 percent chance of dying from it; the average patient dying of colorectal cancer loses 13 years of life.

Unspecified

Colorectal cancer screening is effective in reducing mortality from colorectal cancer. Current data are insufficient to determine the most effective or cost-effective strategy for screening, although all major strategies have favorable cost-effectiveness ratios compared with no screening. Estimates of average cost per year of life saved by having a colonoscopy every 10 years range from approximately $9,000 to $26,000.

• Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults. Systematic Evidence Review No. 7 (prepared by the Research Triangle Institute, University of North Carolina Evidence-based Practice Center under contract No. 290-97-0011). AHRQ Publication No. 02-S003. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2002 Jun 1.

Living with Illness
Staying Healthy

Safety

Users of care only

Procedure specific data are collected in a prospective manner for approximately 3 months for all patients having a colonoscopy (Current Procedure Terminology [CPT] codes 45378-45385).

Patients associated with provider

Inclusions
Patients undergoing colonoscopy procedure (Current Procedure Terminology [CPT] codes 45378-45385) at the ambulatory health care organization

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Diagnostic Evaluation

Time window is a single point in time

Inclusions
Number of patients from the denominator who developed one or more intra-procedure complications*

*Complications include arrhythmia, bleeding requiring treatment/intervention, extended recovery, hospital transfer, hypotension, hypoxia, noted perforation(s), respiratory arrest.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Encounter or point in time

Patient survey

Not Individual Case

Adverse Outcome

Unspecified

Rate

Better quality is associated with a lower score

Unspecified

External comparison at a point in time
External comparison of time trends
Internal time comparison

Limited reliability and validity testing have been completed.

Reliability testing has included comparing information in the surveys to patients' charts and surgical logs - different sources of much the same data.

Validity testing has included examining face validity, content validity, and external validity (generalizability), with survey developers and participating organizations from year-to-year.

Unfortunately, there is little in the way of established measures to test criterion validity.

• AAAHC Institute for Quality Improvement. Colonoscopy 2003 study. Wilmette (IL): Accreditation Association for Ambulatory Health Care, Inc. (AAAHC); 2003. 21 p.

Intra-procedure complication rate.

Accreditation Association for Ambulatory Health Care Institute for Quality Improvement

Accreditation Association for Ambulatory Health Care Institute for Quality Improvement, Performance Measurement Initiative, Colonoscopy Work Group

Accreditation Association for Ambulatory Health Care (AAAHC)

Sam JW Romeo, MD, MBA, Chair, AAAHC Institute Performance Measurement Initiative (PMI); Deborah Jinks, RN, CPHQ, Chair, AAAHC Institute Ambulatory Surgery Work Group; Dianna Burns, CGRN, Member, PMI Colonoscopy Work Group; Lawrence M. Kim, MD, Member, PMI Colonoscopy Work Group; Deborah P. Robin, MSN, RN, CHCQM, Member, PMI Colonoscopy Work Group; Michael A. Safdi, MD, Member, PMI Colonoscopy Work Group; Naomi Kuznets, PhD, Director, AAAHC Institute for Quality Improvement; Anita Kneifel, Assistant Director, AAAHC Institute for Quality Improvement

Drs. Romeo, Kim, and Safdi and Ms. Jinks are members of the Accreditation Association for Ambulatory Health Care (AAAHC) Institute or AAAHC Boards and as such must complete conflict of interest forms.

Ms. Burns has completed conflict of interest forms for AAAHC Institute presentations (including ones on this study).

Ms. Robin is on staff at the American Gastroenterological Association.

Ms. Kneifel and Dr. Kuznets are on staff at AAAHC Institute, and as such, must complete forms disclosing any conflicts of interest.

There have been no conflicts of interest stated on any of the COI forms aforementioned.

Measure was not adapted from another source.

2000 Jan

2003 Jan

This is the current release of the measure.

• AAAHC Institute for Quality Improvement. Procedure specific colonoscopy survey [Colonoscopy CPT-45378-45385]. Wilmette (IL): AAAHC Institute for Quality Improvement; 2003. 2 p.

The following is available:

• Colonoscopy 2003 study. Wilmette (IL): Accreditation Association for Ambulatory Health Care, Inc. (AAAHC); 2003. 21 p.

This NQMC summary was completed by ECRI on May 25, 2004. The information was verified by the measure developer on May 27, 2004.