What Does the AGA Digestive Health Outcomes Registry™ Mean to Your Practice?
The mission of the AGA Registry is to improve patient health outcomes and cost effectiveness of digestive care using scientifically valid methods to collect, analyze and report clinically relevant data, empowering the health-care community to optimize quality of care.
During this decade, physicians will be measured on quality, cost, efficiency and value of care. In order to manage performance, physicians will need to demonstrate impacts and outcomes to payors, purchasers, patients and other providers. Understanding resources used and recognizing incremental change leads to continuous improvement and achieving excellence, which adds value to patients.
So what does this mean to your practice, your staff and your patients? An overview of the data entry process, measures and feedback reports will address those questions.
As of May 2010, the registry addresses two patient categories: IBD and colorectal cancer prevention (CRC-P).
Performance measures for the AGA Registry are developed in a collaborative process. An expert panel of GI physicians from community and academic practice settings, and clinical practice workflow experts were identified to develop a performance measure set for CRC-P and IBD. Specific desirable patient outcomes and care processes were identified based on scientific evidence and clinical practice guidelines. The clinical measures, data elements and definitions were based on the practical availability of the desired information and the form (paper and electronic) that these data are currently available in gastroenterology practices.
The data is entered into a secure, HIPAA-compliant, Web-based tool. Since data entry can be done following the patient’s visit, workflow changes are expected to be minimal. Practices can expect to spend no more than three to five minutes per patient for data entry. We are working with electronic medical record vendors to enable direct data entry, which will minimize the impact of the data collection process.
Feedback About Your Practice
Based on the data collected, the AGA Registry calculates the following measures for each physician.
Colorectal Cancer Prevention Measures
CRC-P 1: Identification of CRC Risk
This measure is designed to evaluate the rate at which a physician has made a preliminary assessment of the risk category, average- or high-risk, for each patient having a diagnostic colonoscopy or CRC screening/surveillance. This measure will assist in quantifying the rate at which patients are evaluated for their individual risk of CRC and facilitate an understanding of the accuracy of the pre-procedure assessment, following an endoscopic examination, to inform the risk stratification process of the physician following the presentation of unknown findings discovered during the examination.
CRC-P 2: Endoscopic Examination Interval
This measure is designed to assess what the endoscopist has determined to be the appropriate follow-up interval for colonoscopy by post-procedure risk classification. This measure will take into consideration the physician’s determination of CRC-P risk factors following the endoscopic examination based on the examination findings, the examination type (e.g., flexible sigmoidoscopy, colonoscopy) and presenting characteristics (current CRC risk classification, family history of CRC, other bowel conditions, bleeding and/or genetic syndromes associated with high incidence of CRC). This measure will assist with the evaluation of national, regional and local endoscopic utilization trends and assist in the identification of possible over- and under-utilization of endoscopy in the process of CRC prevention.
CRC-P 3: Use of Anesthesia Professionals
This measure is designed to evaluate the utilization rates of anesthesia professionals in endoscopic CRC-P procedures. The evaluation will consider patient factors such as American Society of Anesthesiologist (ASA) class and facility staff. This measure will assist with the evaluation of national, regional and local rates of anesthesia professional utilization and compare those rates against the recommendations for anesthesia professional utilization that are described in the “AGA Institute Review of Endoscopic Sedation.”
CRC-P 4: Procedure-Related Complications
This measure is designed to provide an understanding of the rate of complications that are related to endoscopy procedures and to assess the degree to which these events may be eliminated to identify and manage the risk factors associated with these complications. The measure will consider the presence of patient conditions such as anticoagulation for unrelated conditions, patient ASA class, endoscopy staff patterns and roles, use of anesthesia professionals, and other factors.
CRC-P 5: Colonoscopy Assessment (Procedural Adequacy)
This measure is designed to provide an understanding of the rate of procedures where examination is determined by the endoscopist as complete. It takes into consideration whether or not the colon preparation was sufficient to allow exam of the entire colon and if any cancer or pre-cancerous areas were treated and/or identified for subsequent intervention. The measure will assist in understanding the relationship of procedural adequacy relative to the adenoma detection rates and the long-term incidence rates of CRC.
CRC-P 6: Adenoma Detection Rate
This measure is designed to report the rate at which an endoscopist detects the various adenoma/cancer morphologies that may be identified and/or treated during an endoscopic examination. The measure will include an evaluation of the rates of detection by various polyp and cancer morphology, and will be reported by practice and endoscopist compared to national trends gathered in the registry as well as external benchmarks for rates of detection.
IBD 1: Patients Managed with Steroid Therapy
This measure is designed to provide a description of the patients within a physician’s practice that are on an ongoing course of systemic corticosteroid therapy at a prednisone equivalent dose of 10mg or more, per day. This measure is designed to provide practice management assessment to assist physicians treating patients with IBD — stratified by ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis (IC) — and to minimize the exposure of these patients to corticosteroids, where possible, to reduce the risk of injury associated with prolonged exposure to steroid therapy.
IBD 2: Minimization of Steroid Exposure
This measure is designed to describe the patients, in a state of remission, that have been withdrawn from corticosteroid therapy for >90 days by duration of therapy. The measure accounts for the duration of completed corticosteroid therapy, condition (UC, CD or IC), the extent of the conditions according to the affected areas of the gastrointestinal tract, and acuity. This measure provides a comparative description of the prescribing patterns and duration of systemic corticosteroid therapy across the country and according to practices of similar size, resources and patient acuity.
IBD 3: Patients Managed by Steroid-Sparing Pharmaco-Therapy
This measure is designed to provide a description of patients by condition (UC, CD or IC) that have successfully made a transition from systemic corticosteroid pharmaco-therapeutic agent to a steroid-sparing therapeutic agent for IBD compared by duration of steroid-sparing therapy and then type of agent. This measure provides practice management information about patients within a practice that have been treated with systemic corticosteroids and have successfully moved from corticosteroid therapy to steroid-sparing therapy for management of condition symptoms.
IBD 4: Evaluation of Prophylaxis for Secondary Infection in Immunosuppressive Therapy
This measure is designed to assess the degree to which a physician has evaluated the risk of occult infection of a patient that is being managed on a therapy known to suppress the immune system. This measure will evaluate the rates of potentially avoidable infections in patients that are immune-compromised following therapy for UC, CD or IC.
IBD 5: Evaluation of Assessment of Risk of Iatrogenic Injury Due to Immunosuppressive/Immunomodulator Therapy
This measure is designed to assess the frequency/rate that a physician evaluates IBD patients for their risk of iatrogenic injuries that are possible as a result of therapy known to present a risk of iatrogenic injury, such as bone demineralization and hepatic injury. This measure evaluates the rate of potentially avoidable injuries in patients that are at risk due to the therapeutic regimen chosen to treat UC, CD or IC.
IBD 6: Rate of Secondary Infection
This measure is designed to report the rate of potentially preventable secondary infections that may have resulted from therapy that is known to suppress the immune system. These rates are reported by condition (UC, CD or IC), the extent of the conditions according to the affected areas of the gastrointestinal tract of the patient and the acuity of the patient. This information supports practice management efforts to compare the rates of these events to national and practice type benchmarks to facilitate quality improvement.
IBD 7: Rate of Iatrogenic Injury
This measure is designed to report the rate of potentially preventable injuries that may be associated with the pharmaco-therapeutic regimen selected to manage the symptoms of patients with UC, CD or IC. These rates will be reported by condition (UC, CD or IC), the extent of the conditions according to the affected areas of the gastrointestinal tract of the patient and the acuity of the patient. This measure supports practice management efforts to compare the rates of these events to national and practice type benchmarks to facilitate quality improvement.
IBD 8: Smoking Cessation Counseling
This measure is designed to assess the percentage of patients that have been identified as tobacco users who have been counseled to avoid smoking and the use of tobacco products.
IBD 9: Colon Cancer Surveillance in Patients with IBD
This measure is designed to report on the frequency of colon cancer surveillance for patients with colonic IBD to evaluate the appropriate surveillance interval, as recommended in the clinical practice recommendations for CRC surveillance in patients with IBD. This measure will provide a description of the surveillance interval recommendations for patients by condition (UC, CD or IC), the extent of the conditions according to the affected areas of the gastrointestinal tract of the patient and the acuity of the patient. This will support the assessment of the appropriate utilization rates of endoscopy for CRC surveillance and prevention, and report potential areas of over- and under-utilization of endoscopy.
Participants will receive quarterly and on-demand reports that reflect their individual performance for each measure. You will be able to compare your performance against those in like practices in similar geographic locations. All reports, except those that the individual physician receives, show aggregate data; no one else sees your results. For example, the physician can identify those patients in their panel — that are not in remission — on steroid-sparing treatment so individual patient needs can be addressed. Additionally, because the practice is seeing how it manages a given patient population such as those with IBD, opportunities for improvement can be identified as can those who may have a best practice to share.
To get started you will have to:
- Express interest in registry participation.
- Confirm that your hardware and software meets requirements for compliant and secure data collection.
- Complete the HIPAA business associates agreement with MedAssurant, the AGA Registry’s data partner.
- Register to participate in the registry and pay participation fee.
- Review training materials from MedAssurant.
- Begin submitting data.
- Review feedback reports.
- Identify opportunities for improvement of patient care and share best practices.
- Participate in the Plan-Do-Study-Act cycle for quality improvement.
For more information about the registry or to enroll, go to http://www.agaregistry.org.