As reimbursement shifts from fee for service to value based, it is essential for physicians to focus on the quality – rather than quantity – of services provided. Given that physician reimbursement will increasingly hinge on achieving high-quality health outcomes, it is essential to address how health care "quality" is defined. AGA is committed to leading efforts to define the metrics by which clinical services and health outcomes are judged. As a result, AGA has recently introduced a new process for clinical practice guideline development, utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A complete review of the revised process will be published in the April issue of Clinical Gastroenterology and Hepatology in the "Practice Management: The Road Ahead" column.
Employed by more than 70 organizations and accepted by the National Quality Forum, GRADE is an internationally recognized method to determine the strength of current clinical evidence. The GRADE framework allows for comparison between published studies that vary in methods, comparison populations and statistical strength, allowing clinicians to judge strength of evidence and provide clinical recommendations. A "strong recommendation" means that most patients should receive the recommended course of action, whereas a conditional or "weak recommendation" means that different choices may be appropriate for different patients. Importantly, GRADE provides clear and actionable direction to patients, clinicians, and policy makers.
In addition to utilizing GRADE, the AGA’s new process for clinical practice guideline development fundamentally reshapes how topics are solicited. Beginning this month – and annually every March – AGA will make a "call for topics" to all members. By completing an online form, members may submit topics to be developed within the coming year. The AGA Institute Council will review guideline topics in May, prioritizing and ranking topics based on the following criteria: prevalence of disease, resource utilization, variation in care, other existing guidelines, new data/changes in diagnosis or treatment, and potential for measure/quality development. Once vetted, four new guidelines will be recommended for development across the year.
We encourage you to take part in this important process and submit your topic recommendations. AGA believes that gastroenterologists should define the quality metrics upon which they will be judged and reimbursed. In taking an active role, we can improve patient outcomes and be appropriately rewarded for performing high-quality care.
