Dr. Mariam Naveed
Traditionally, such efforts have been hampered by the lack of systematic clinical data collection. However, as meaningful use of electronic health records increases, measures that incorporate such information are likely to become increasingly feasible. Finally, we also need to consider how to make these improvements while avoiding measure proliferation. Proliferation leads to provider fatigue and discourages thoughtful clinical decision making, potentially worsening quality of care. Creative approaches, such as rotating measure sets over time, use of clinical decision support tools, and balancing underuse measures with overuse measures, may be warranted. Additionally, composite measures may prove to be more meaningful and more practical for patients, providers, and payers. Ultimately, a distinction must be made between quality assurance and quality improvement; both are important, but the types of measures and the level of measure sophistication used in each program undoubtedly vary.
In summary, gastroenterologists are uniquely positioned to advocate for high-quality CRC screening that extends beyond simply providing a high-quality colonoscopy. This broader view of quality benefits patients by ensuring that our expertise informs the metrics by which delivery of CRC screening is measured. It also ensures that we hold ourselves and our colleagues to the highest standards across the continuum of care. Additionally, as alternative payment models and value-based contracting are implemented, nonendoscopic screening methods will likely become more commonplace. Advocating for high-quality nonendoscopic screening will help maintain gastroenterologists’ role as the stewards of CRC screening and digestive health. Although operationalizing measure concepts such as those proposed here may be difficult, it is critical if we are to provide the best possible care for our patients.
References
Dr. Jonathan Rosenberg
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Dr. Saini is a research scientist at the VA Center for Clinical Management Research and an assistant professor of internal medicine at the University of Michigan, Ann Arbor; Dr. Adams is a clinical lecturer in the division of gastroenterology, department of internal medicine, University of Michigan, and a research investigator, VA Center for Clinical Management Research; Dr. Brill is the chief medical officer of Predictive Health, Paradise Valley, Ariz., and a clinical assistant professor of medicine, University of Arizona School of Medicine, Phoenix; Dr. Gupta is codirector of Digestive Health Center, director of interventional endoscopy, and associate professor of medicine in the division of gastroenterology at Loyola University Medical Center; Dr. Naveed is a clinical assistant professor in the department of gastroenterology and hepatology, University of Iowa Hospitals and Clinics; Dr. Rosenberg is at Illinois Gastroenterology Group; and Dr. Gellad is associate professor of medicine at Duke University School of Medicine, Durham, N.C. Dr. Saini’s and Dr. Gellad’s research is funded by Veterans Affairs Health Services Research and Development Career Development Awards (CDA 09-213-2 and CDA 14-158). Dr. Gupta has received research support from Cook Medical, Cosmo Pharmaceuticals, and CDx Diagnostics.
