Abstract and Introduction
Abstract
Objectives The Affordable Care Act emphasizes the use of quality metrics and greater patient understanding of health-care options and access to physician performance data. The objectives of this study were to determine patients' familiarity with colonoscopy quality measures (CQMs) and their influence on patient selection of a colonoscopist.
Methods A prospective survey of patients before screening or surveillance colonoscopy at university hospital, community hospital, and ambulatory procedure center endoscopy units was performed from 2011 to 2012.
Results Among the 417 participants, 20% (85/417) researched their physician's rating. The rates of familiarity with CQM were 88 % (353/402) for adequate bowel preparation, 30% (118/398) for adenoma detection rate (ADR), 26% (102/397) for cecal intubation rate, and 21% (82/394) for greater-than-6-min withdrawal time. Ninety-six percent (366/386) believed that colonoscopists' reporting of ADR to other physicians was important or very important. In selecting a colonoscopist, primary care provider referral was ranked as the first or second-most important of four factors in 87% (339/391). Even among patients who responded "it is very important" to report CQM to other doctors and patients, none ranked CQM as the most important factor in selecting a colonoscopist.
Conclusions Patient awareness of CQM, other than adequate bowel preparation, was low. Quality measure reporting is important to patients, but primary care provider referral was the most important factor in colonoscopist selection. This suggests that primary care providers, as well as patients, are important to include in educational strategies regarding quality metrics.
Introduction
Approximately 17 million colonoscopies are performed each year in the United States. The effectiveness of colonoscopy in reducing colorectal cancer is influenced by multiple factors including the quality of the bowel preparation, the colonoscopist's cecal intubation rate, the time taken to inspect the colon (withdrawal time), and the adenoma detection rate (ADR). Significant variability has been demonstrated in reducing the development of colorectal cancer by colonoscopy, particularly in the proximal colon. Reporting, benchmarking, and optimization of colonoscopy quality measures (CQMs) has been advocated by national gastroenterology organizations, and national online registries have been created.
The Patient Protection and Affordable Care Act has several sections devoted to a "quality agenda", including linkage of quality metrics to reimbursement. The Patient-Centered Outcomes Research Institute, created within the Affordable Care Act, seeks to "give patients a better understanding of the prevention, treatment, and care options available, and the science that supports those options" along with web-based access to data on physician performance. Colonoscopy quality issues have also been discussed in the popular media.
We do not know whether patients have any familiarity with colonoscopy quality data reporting or whether patients' knowledge of specific physician's CQM data would affect their choice of a colonoscopist. Therefore, we performed a survey of patients undergoing outpatient screening or surveillance colonoscopy to determine their awareness of CQM and their importance in selecting a specific colonoscopist.