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 Outcomes Registry® (AGA Registry).
- 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 development include:
- ASC safe surgical checklist.
- Barrett’s esophagus.
- Colonoscopy surveillance for colorectal cancer.
- Endoscopic procedures and potentially avoidable complications.
- Dyspepsia and Helicobacter pylori.
- Inflammatory bowel disease — pediatric.
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 AGA has begun developing performance improvement modules (PIMs), which can be completed by physicians for the American Board of Internal Medicine’s maintenance of certification and state maintenance of licensure programs. The PIMs, by design, are cross-functional; for example, the AGA PIM on endoscopic sedation supports measures related to endoscopy performance and complications and colorectal cancer screening and surveillance. Over the coming years, as the AGA releases additional PIMs linked to guidelines and measures, the AGA Registry will facilitate data collection documenting physician compliance with educational activities and performance improvement.
Following is a summary of a proposed measure set for gastroenterology. With the exception of the “potentially avoidable complication” measure for colonoscopy, all measures listed in the initial measure set are being collected within the AGA Registry. The AGA Registry is certified by CMS to submit Physician Quality Reporting System (PQRS) data for the hepatitis C measures group on behalf of eligible professionals.
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 |
|
| GERD/Barrett’s esophagus | PCPI approved — 2007 Update — 2012 |
Jointly with PCPI, ASGE, Society of American Gastrointestinal and Endoscopic Surgeons, American College of Radiology |
|
| Endoscopy and polyp surveillance | PCPI approved — 2008 Coding updated — 2010 |
Jointly with PCPI, ASGE, ACG and American Society of Colon and Rectal Surgeons. |
|
| Adult IBD | 2011 | Independent PCPI process with Crohn’s and Colitis Foundation of America. |
|
| Non-esophageal upper GI disorders: dyspepsia, H. pylori and ulcer disease | In process | AGA/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition multi-stakeholder process. | Work group meeting Dec 2011. |
| Pediatric IBD | 2012 | AGA convened multi-stakeholder. | Work group meeting 2012. |
Further details regarding the measures are available at http://www.gastro.org/practice/quality-initiatives/performance-measures and http://www.gastro.org/practice/digestive-health-outcomes-registry/clinical-content.
Updated December 2011
