AGA Quality and Outcomes Measures

Identifying high-value gastroenterology practices has been a challenge for patients, payors and purchasers of health benefits. Since 2005, the AGA Institute has been developing measures related to the quality, efficiency and outcomes of digestive health services. The AGA recognizes the need to distinguish physicians and practices that deliver high quality and resource-efficient care for patients with digestive disorders.

Several events have occurred that facilitate development of a valid measure set that will achieve this goal:

  • Government and private sector initiatives supporting value-driven health care, avoiding waste and overuse.
  • Definition of a single measure endorsement process through the National Quality Forum (NQF).
  • AGA development of the Digestive Health Recognition Program™ (DHRP)
  • Expert consensus around the need for a valid GI measure set focused on outcomes.

While there is broad agreement on the areas of gastroenterology where there is variability in clinical outcomes and resource efficiency, definition of valid measures that distinguish high performing practices has, until recently, been lacking. The AGA has been leading the effort to develop measures through a transparent, multi-stakeholder, multi-specialty society process. Additionally work with NQF, the National Committee for Quality Assurance (NCQA), the AQA Alliance, the Physician Consortium for Practice Improvement™ (PCPI), the Health Care Incentive Improvement Institute, the high value health care through better information and quality improvement initiative, and other entities has lead to endorsement and implementation of measures into routine practice.

To date, the AGA, in partnership with specialty societies, payors and other experts, has developed measures in several areas of gastroenterology practice:

  • Colorectal cancer screening and surveillance.
  • Colonoscopy performance and efficiency.
  • Inflammatory bowel disease — adult.
  • Hepatitis C.
  • Gastroesophageal reflux disease (GERD).

Additional measures in various stages of planning and development include:

  • ASC safe surgical checklist.
  • Inflammatory bowel disease — pediatric.
  • Adenoma detection rate.
  • Barrett’s esophagus.
  • Colonoscopy surveillance for colorectal cancer.
  • Endoscopic procedures and potentially avoidable complications.
  • Dyspepsia and Helicobacter pylori.

The AGA recognizes that a gastroenterology measure set will include process, efficiency and outcome measures. Data collection can be achieved using electronic health records, the AGA Registry and administrative data by participating payors. The data set needed to produce measures is defined, in the public domain and available for widespread use. The initial measures have been judged to be important by nationally recognized content experts and most have been or are in the process of endorsement by the NQF.

The development of measures is only one part of the transition to value-driven health care. Continuing education programs should be based on an assessment of the individual physician’s knowledge base, supported by the data that identifies educational opportunities for improvement. Recognizing such,

The development of measures is only one part of the transition to value-driven health care. Continuing education programs should be based on an assessment of the individual physician’s knowledge base, supported by the data that identifies educational opportunities for improvement. Recognizing such, the AGA provides resources to physicians who need to earn American Board of Internal Medicine (ABIM) Part 4 self-evaluation of Practice Performance Maintenance of Certification (MOC) points. Part 4 MOC can be claimed through the ABIM’s self-directed Practice Improvement Modules (PIM). These resources are available through the AGA Digestive Health Recognition Program, enabling physicians to enter patient data for recognition and calculate performance measures for MOC credit. 
 
Following is a summary of a proposed measure set for gastroenterology. With the exception of the “potentially avoidable complication” measure for colonoscopy.

Colonoscopy performance

  • Rate of precancerous polyps and cancers identified during initial colon cancer screening exams (adenoma detection rate)
  • Rate utilization of anesthesia professional to administer sedation for colonoscopy in ASA class I-II patients undergoing screening examination
  • Rate of potentially avoidable complications during the “colonoscopy episode” (seven days pre-colonoscopy and 14 days post-colonoscopy)

Colorectal cancer screening and surveillance

  • Performance of colorectal cancer screening test(s) in eligible population (50-75) (NQF 0034) 
  • Colonoscopy interval for patients with a history of adenomatous polyps (PQRS 185)

Inflammatory bowel disease

  • IBD: type, anatomic location and activity documented (PQRS 269)
  • IBD: preventive care: corticosteroid sparing therapy (PQRS 270)
  • IBD: preventive care: corticosteroid related iatrogenic injury — bone loss assessment (PQRS 271)
  • IBD: preventive care: influenza immunization (PQRS 272)
  • IBD: preventive care: pneumococcal immunization (PQRS 273)
  • IBD: testing for latent TB before initiating anti-TNF therapy (PQRS 274)  
  • IBD: assessment of hepatitis B status prior to initiating anti-TNF therapy (PQRS 275)
  • Testing for Clostridium difficile in IBD patients who develop diarrhea

Hepatitis C (current PQRS measure set)

  • Ribonucleic acid (RNA) testing before initiating treatment (PQRS 83)
  • HCV genotype testing prior to treatment (PQRS 85)
  • Hepatitis C: antiviral treatment prescribed (PQRS 86)
  • HCV ribonucleic acid (RNA) testing at week 12 of treatment (PQRS 87)
  • Counseling regarding risk of alcohol consumption (PQRS 89)
  • Counseling regarding use of contraception prior to antiviral therapy (PQRS 90)
  • Hepatitis A vaccination in patients with HCV (PQRS 183)
  • Hepatitis C: hepatitis B vaccination in patients with HCV (PQRS 184)

Obesity

  • BMI screening and follow-up (NQF 0421, PQRS 128)

Preventive measures

  • Influenza immunization assessed (PQRS 110)
  • Pneumococcal vaccination assessed (PQRS 111)
  • Tobacco use counseling and cessation (PQRS 226)
  • Documentation of current medications in the medical record (PQRS 130)
  • Hypertension: BP measurement recorded (PQRS 237)

Following is a summary of the AGA Institute’s measures development work. 

GI Measure Year Published Development Process Status
Polyp surveillance performance measures 2006 AGA convened multi-stakeholder work group Incorporated into “endoscopy and polyp surveillance” measures.
Hepatitis C PCPI approved — 2006
Updated — 2008
Coding updated — 2010
Jointly with PCPI and AASLD
  • Included in PQRS as individual measures and measures group (83-90, 183-184).
  • Workgroup reconvened June 2012 to consider new evidence.
GERD/Barrett’s esophagus PCPI approved — 2007
Update — 2012
Jointly with PCPI, ASGE, Society of American Gastrointestinal and Endoscopic Surgeons, American College of Radiology
  • Initially included in Physician Quality Reporting Initiative, but not part of PQRS.
  • AGA is working with the AMA/PCPI to identify a process to update and maintain these measures. 
Endoscopy and polyp surveillance PCPI approved — 2008
Coding updated — 2010
Jointly with PCPI, ASGE, ACG and American Society of Colon and Rectal Surgeons.
  • Surveillance colonoscopy interval with hx/of adenomatous polyp included in PQRS (#185). 
  • This measure and surveillance interval after normal colonoscopy endorsed by NQF in 2011.
Adult IBD 2011 Independent PCPI process with Crohn’s and Colitis Foundation of America.
  • AGA and PCPI approval in 2011.   
  • Outpatient measures included in PQRS 2012 as registry measure group. 
  • Will be submitted to NQF in 2012.
Pediatric  IBD In process AGA /NASPGHAN multi-stakeholder process. Work group meeting Dec. 2011.
Adenoma detection rate In process Jointly with ASGE and ACG. Work group has convened.

 

Further details regarding the measures are available at gastro.org/practice/quality-initiatives/performance-measures and gastro.org/practice/digestive-health-outcomes-registry/clinical-content.

 

Updated June 2012