April 26, 2012 Home|Journals & Publications|  AGA eDigest
AGA eDigest

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Quality Benchmarking — Making Data Your Friend

If one were to summarize the national quality agenda, it would be “better care, better health and lower costs through improvement.” As health care moves from a service-performance to an outcomes-based environment, reimbursement will be driven by measurement of value and quality, not process. Choosing what to measure and how to report it is a critical component of the quality journey. What does this mean to the practicing clinician? In an article in this month’s AGA Quarterly: Practice newsletter, Joel V. Brill, MD, AGAF, CHCQM, addresses this question and guides you through quality benchmarking.


Extracorporeal Procedure Does Not Aid in Survival

Fractionated plasma separation and adsorption is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from acute-on-chronic liver failure (AOCLF). A study in Gastroenterology finds that among all patients with AOCLF, extracorporeal liver support with fractionated plasma separation and adsorption does not increase the probability of survival. Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients.
Gastroenterology 2012: 142(4): 782-789.e3

Albendazole Therapy Decreases Enteric Parasites in Refugees

Beginning in 1999, the CDC recommended presumptive treatment of refugees for intestinal parasites with a single dose of albendazole (600 mg), administered overseas before departure for the U.S. Data appearing in the New England Journal of Medicine suggests that presumptive albendazole therapy administered overseas before departure for the U.S. is associated with a decrease in the prevalence of intestinal nematodes among newly arrived African and Southeast Asian refugees.

New England Journal of Medicine 2012; 366: 1498-1507

BMI Increases Colorectal Adenoma Risk

There have been inconsistent results published about the relationship between excess body weight, expressed as increased body mass index (BMI), and risk of colorectal adenoma. A study in Gastroenterology states that increased BMI increases the risk for colon but not rectal adenoma. Unlike colorectal cancer, there is no gender difference in the relationship between increased BMI and risk of colorectal adenoma.

Gastroenterology 2012: 142(4): 762-772

Will the Need for Biological Therapy Increase Dramatically?

IBD has become a global disease, and its incidence in developing countries is rising. In Asia, this has been attributed to the rapid modernization and westernization of the population. As IBD emerges in developing nations, there is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost, stated researchers in an article published in Gut. Other items that should be considered: the potential need for biological therapy in developing countries to treat IBD, the necessary infrastructure for selecting patients with IBD who need biological therapy, and medical/ethical issues limiting the use of biological therapy.

Gut 2012; 61: 706-712


Prepare for Patient Questions About Equipment Reprocessing

Although the chances of acquiring an infection from reusable medical equipment are low, the FDA has developed consumer information on the issue. The agency encourages patients to ask health-care providers and facility staff about their equipment reprocessing procedures.

Stay up to date on the latest safety news by reading this and related articles in the AGA Quarterly: Quality newsletter.

CMS Updates FAQ about Attesting with Multiple EHRs

Understanding how electronic health record (EHR) incentive program objectives and clinical quality measures are calculated for gastroenterologists practicing in multiple settings can be confusing. The following FAQ update from CMS provides some new information and clarification regarding those calculations.

Question: How should an eligible professional (EP), eligible hospital or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures?

Answer: EPs, eligible hospitals and CAHs should look at the measure of each meaningful use objective to determine the appropriate calculation method for individual numerators and denominators. The calculation of the numerator and denominator for each measure is explained in the July 28, 2010, final rule (75 FR 44314).

For objectives that require a simple count of actions (e.g., number of permissible prescriptions written, for the objective of "Generate and transmit permissible prescriptions electronically"; number of patient requests for an electronic copy of their health information, for the objective of "Provide patients with an electronic copy of their health information"; etc.), EPs, eligible hospitals and CAHs can add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure.

For objectives that require an action to be taken on behalf of a percentage of "unique patients" (e.g., the objectives of "record demographics," "record vital signs," etc.), EPs, eligible hospitals and CAHs may also add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure. Previously, CMS had advised providers to reconcile information so that they only reported unique patients. However, because it is not possible for providers to increase their overall percentage of actions taken by adding numerators and denominators from multiple systems, we now permit simple addition for all meaningful use objectives.
Please keep in mind that patients whose records are not maintained in certified EHR technology will need to be added to denominators whenever applicable in order to provide accurate numbers.

To report clinical quality measures, EPs who practice in multiple locations that are equipped with certified EHR technology should generate a report from each of those certified EHR systems and then add the numerators, denominators and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters at those locations. To report clinical quality measures, eligible hospitals and CAHs that have multiple systems should generate a report from each of those certified EHR systems and then add the numerators, denominators and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters in the relevant departments of the eligible hospital or CAH (e.g., inpatient or emergency department [POS 21 or 23]).

Read CMS' list of top questions.


Your AGA Research Foundation Gifts Support …

 … Yunzhou Li, for research conducted at the Virginia Commonwealth University, who received the 2011 AGA-Stuart Brotman Student Research Fellowship Award.

"I would like to give my thanks to the members of the AGA Research Award panel for granting me this award, for it is with great honor that I receive it. As an undergraduate at the University of Virginia, I've come to realize the importance of research and also the difficulty of coming across research opportunities. This award will provide me with another valuable opportunity to conduct research in a laboratory, increase the depth of my knowledge with regards to proper research and scientific technique, and work with knowledgeable people in the field. I've come to discover the true value and meaning of research."

"Despite research being limited in techniques and equipment, the ideas and topics are limitless. It is the researchers that are at the forefront of the scientific field, pushing the boundaries of our human knowledge and understanding further. For me, to be able to have this ability to walk into and explore uncharted territory is both exciting and motivating. It is undeniable that medicine begins with research. Even from my research topic alone, this connection can be seen, as the results of my research can have an impact on the medical field as I look into a new direction of therapeutics for NAFLD, affecting a third of the adult population here in the U.S."

To make a donation, visit www.gastro.org/contribute.


Medicine vs. Surgery for Crohn’s: Which Is Better?

The AGA Journals Blog post, "Is Medicine or Surgery the Best Treatment for Crohn’s Disease?" was our most retweeted post last week. What other topics were popular?

  • Is infliximab safe, effective for children with moderate to severe UC? Read more about this study in CGH: ow.ly/aj5ox.
  • Gastro article-in-press—Nationwide colonoscopy screening is efficacious when highly qualified endoscopists participate ow.ly/ajqB2.
  • Join celiac expert dietitian & leading gourmet chef for hands-on gluten-free health workshop; July 6-8, Rhinebeck, NY bit.ly/zGsc70.

Have any news that you would like us to share with our AGA members? Please send them to communications@gastro.org or share them on our social media channels:


Learn About AGA Academy of Educators at Plenary Session

The AGA has launched an Academy of Educators to support the career aspirations of clinician-educator and basic scientist teacher members of AGA. The academy will serve as the home for educators within AGA, will advocate for education as both an academic priority and a career pathway, and will recognize excellence in education.
You can learn more about the academy, its mission and its criteria for membership at DDW® 2012. The academy will hold a plenary session on Tuesday, May 22, from 8:30 to 10 a.m. in the Hilton San Diego Bayfront Hotel adjacent to the San Diego Convention Center. A breakfast buffet will be provided.
The session will begin with introductions from academy directors and charter members. Helen M. Shields, MD, AGAF, will discuss “How to Succeed in Academic Teaching and Education Endeavors,” and Suzanne Rose, MD, MSEd, AGAF, will present “Promoting Scholarship in GI and Liver Education.” Roundtable discussions including expert teachers and other board members of the academy will follow. Discussion topics will include developing successful strategies for teaching, a review of opportunities for scholarship and academic advancement in GI and liver medical education, and an overview of successes in and barriers to advancement in medical education.
All AGA members who are involved in teaching are invited to attend the session. Participants will learn how to join the academy and will receive a waiver of the $25 application fee.
This activity is supported by a grant from Pfizer, Inc.

Only One Day Left To Vote

The AGA Institute Council is holding elections for six new vice chairs and nominating committee members. Voting will end on April 27, 2012. For more information or to cast your vote, please visit http://gastro.org/councilelections.

Are You Up for a Clinical Challenge?

Congratulations to Mauro Demurtas and Sanae Reggoug, MD, our latest Clinical Question of the Month winners, for March and April, respectively.

AGA’s Clinical Question of the Month contest has proven to be a fun, new way for GI clinicians and other medical professionals to test their clinical awareness. With more than 350 board-type self-assessment questions to choose from, each month is sure to offer a new and unique challenge to assess your understanding of the Digestive Diseases Self-Education Program® 6.

The next question will be posted on Monday, May 7 on the AGA Facebook page. Submitting the correct answer qualifies participants to be entered into a raffle drawing for a chance to win a valuable prize.

To ensure that you receive proper access to the question, you must have an active Facebook account and “like” the AGA page. By liking the page, your news feed will display updates from AGA’s page.

For more information on game rules and prizes, visit www.gastro.org/cqom.


Call for Papers on Clinical Trials: Gastroenterology

Gastroenterology is committed to advancing clinical practice in the field of digestive disease. Recognizing that clinical trials generally have the greatest impact of all studies on clinical practice, Editor Bishr Omary, MD, PhD, and his associate editors strongly encourage authors to submit their manuscripts on clinical trials (diagnostic validation, therapeutic efficacy) of drugs, biological materials and devices in digestive, liver and pancreatic diseases, including studies at Phases I, II and especially III, to Gastroenterology for consideration. The journal is also interested in publishing trials in endoscopic and imaging modalities.

There are several important reasons to submit clinical trial research for publication in Gastroenterology:

  • With an impact factor of 12.9, Gastroenterology is the premier journal in the field.
  • Gastroenterology is the journal that will directly reach the largest portion of physicians who care for and make treatment decisions for patients with GI or liver disease.
  • Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer.
  • Accepted manuscripts will be published online and indexed on PubMed within 10 days of acceptance.

To submit your manuscript to Gastroenterology, go to www.editorialmanager.com/gastro.

For important information on how to report clinical trials, go to www.gastrojournal.org/authorinfo. To review the current and past issues of the journal, go to www.gastrojournal.org.

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Place GI Position Listings and Activity Announcements

For as little as $82.50, you can place a classified ad of 100 words or less in AGA's weekly e-mail newsletter, AGA eDigest, or AGA's bi-monthly magazine, AGA Perspectives. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. Advertising in either includes a free online classified listing. Learn more.

Feinberg School of Medicine Northwestern University
Associate Professor or Professor and Chief, Division of Gastroenterology and Hepatology

Northwestern University seeks an exceptional individual to direct the division of gastroenterology/hepatology. The division currently is comprised of over 40 faculty members, with broad interests in basic and clinical research, education and clinical care. Patient care is provided through Northwestern Memorial Hospital, Northwestern Medical Faculty Foundation and the Jesse Brown VA Medical Center, as well as associated hospitals of the McGaw Medical Center (Children's Memorial Hospital and The Rehabilitation Institute of Chicago). The division works in close collaboration with many departments, institutes and centers across the Feinberg School of Medicine in a variety of areas related to gastroenterology/hepatology.

The ideal candidate should be a nationally recognized leader with an established record of academic accomplishment in research, education and clinical care. The selected candidate will also be committed to shaping and growing a division that sets the standards of a 21st century department of medicine and medical school. These standards include advanced leadership ability, a demonstrated commitment to collaboration and interdisciplinary activities, and a passion for success in all areas of the tripartite mission.

A medical degree and board certification are required. This is a full-time faculty position. Salary will be commensurate with experience. The successful candidate will be tenured at the rank of associate or full professor. The proposed start date is Sept. 1, 2012. To ensure full consideration, interested candidates should submit a curriculum vitae by June 1, 2012, to:

Gastroenterology/Hepatology Search Committee
c/o Diane B. Wayne, MD
Vice – Chair, Department of Medicine
251 E Huron St. Galter 3-150
Chicago, IL 60611

The Feinberg School of Medicine is an affirmative action/equal opportunity employer. Women and minorities are encouraged to apply. Hiring is contingent upon eligibility to work in the United States.