Calculating Quality in the Gastroenterology Practice

By Peter Donaldson
Digestive Health Specialists, PA
Winston-Salem, NC

As the administrator of a gastroenterology practice, I encourage friends and associates to get a screening colonoscopy for colon cancer prevention. So when a good friend told me he was ready to make an appointment to come in for his screening colonoscopy, I was pleased. He then asked the question “Which one of the doctors in your group would you recommend to perform my procedure?” I gave him my well-rehearsed, standard answer, “Any one of our doctors will do an excellent job!”

I am not sure whether it was because I had been asked that question 1,000 times or that it was a close friend who was asking, but I realized that I didn’t have any data to back up my answer. We rate and rank golf courses, vacation spots, places to live, hotels and restaurants, but what about physicians? Are all of the doctors in my group really providing excellent care? Is one physician substantially better than another? How do they rank when compared to peers? Are they meeting a particular quality standard?

As I searched for answers, I found Minnesota Gastroenterology’s Outcomes report posted on their Web site. The report listed their group’s adenoma detection rates. I also found the article by Rex DK, et al. “Quality Indicators for Colonoscopy,” (Gastrointestinal Endoscopy 2006;63:S16-S28), which states that when healthy asymptomatic patients undergo a screening colonoscopy, adenomas should be detected in greater than or equal to 25 percent of men and greater than or equal to 15 percent of women more than 50 years old. Now I had some standards with which to begin the measurement process.

I wondered how my physicians compared to this quality standard. We use gMed’s electronic medical record (EMR) and endoscopy report writing software in our practice, so I knew we had lots of data. But did we have the right data and could we turn this wealth of data into the needed information and knowledge? Using Excel and SQL Query Wizard to join tables and filter information, I identified the ”colonoscopy indications” field, which contained the data needed to determine the type of colonoscopy performed. With a few clicks in Excel, I was able to get the number of total screening colonoscopies in our practice, sorted by doctor and patient gender.

I then turned to our pathology results. We send our pathology to a vendor, which has an interface to our EMR so all pathology results are received and stored electronically in our EMR database. I located these stored results in the database, used Excel and the SQL Query Wizard to identify the “‘type of pathology diagnosis” field, which contained the adenoma polyp’s diagnosis and sorted the results by the performing physician and patient gender.

With this data, I was able to produce a report showing each individual physician’s total number of screening colonoscopies and his/her calculated adenoma detection rate. I was pleased to learn that all of our physicians had detection rates above the national quality standard of 15 percent for females and 25 percent for males.

While all of the physicians had detection rates above the national benchmark, each physician had a unique detection rate. This variation will be important for us to track, investigate and understand. For now, each physician knows his/her personal adenoma detection rate and how he/she compares to a national benchmark and to each of the physicians in our group. Knowing their number and how they rank gives the physicians a specific data point and the opportunity to improve.

More importantly, as we begin making this information part of our quarterly quality reviews, we are confident that we will see less variation between the doctors and an overall improvement in the total numbers for our practice. We also now have a standardized method for measuring the quality of our screening colonoscopy services and monitoring that quality.

What’s next? We will be publishing a quality report that will include our adenoma detection rate as compared to the national quality standards. This report will be distributed to our referring physicians and will be posted on our Web site for review by patients and insurers. We will use this information when negotiating with insurance companies as well.

So what did my good friend do? He ended up selecting his physician based on a chance encounter at a social gathering. But he will be returning to see us in several years, as an adenomatous polyp was found and removed during his screening colonoscopy. He has already referred several of his friends and associates to our practice for a screening colonoscopy and is one of our biggest advocates that colonoscopy screening proves to be effective in colon cancer prevention.

It is my hope that in the future, patients will make an informed choice with real data based on the physician’s medical skills, not just their social skills. Using the results of our data analysis, I now have the hard facts behind my statement, “Any one of our doctors will do an excellent job!”

About the Author

Peter Donaldson is the CEO/administrator of Digestive Health Specialists, P.A. in Winston Salem, NC. He is a member of the AGA Institute Practice Management and Economics Committee and is a past president of the Medical Group Management Association (MGMA) Gastroenterology Administrators Assembly.