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Takeaway: The VA Endoscopy Quality Improvement Program (VA-EQuIP) is the largest colonoscopy quality assurance program in the US and has been implemented across the national VA healthcare system. The program is driving efforts to ensure every Veteran is receiving maximal benefit and high-quality colorectal cancer screening and surveillance. As of March 2023, 73 VA sites and 528 providers were enrolled.
Colorectal cancer (CRC) is the third most common cancer diagnosed in both men and women in the United States. From 2011 to 2019, incidence rates dropped by about 1% each year. However, in people younger than 50, rates have been increasing by 1% to 2% each year since the mid-1990s.1 Further, every year VA diagnoses 4,000 new cases of CRC in Veterans.2
The Measurement Science QUERI National Program was created to integrate measurement science (i.e., theory, practice, and application of metrics) into healthcare for Veterans, thereby enhancing VA’s Learning Healthcare System.
National VA and local facilities strive to ensure that Veterans receive high-quality colonoscopy for CRC prevention, but there is no automated mechanism to continually measure or report quality. Thus, VA/HSR&D’s Measurement Science QUERI team collaborated with HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VHA National Gastroenterology & Hepatology Program, and the VA Colonoscopy Cohort to improve Veterans’ access to high-quality colonoscopy for cancer screening and polyp surveillance. They developed a novel informatics infrastructure for centralized colonoscopy quality reporting across VA, which enabled the implementation of the VA Endoscopy Quality Improvement Program (VA-EQuIP) to directly address VA’s critical need to implement evidence-based colonoscopy quality measurement and reporting.
VA’s current infrastructure includes a framework for scalability, prospective updates, and a secure website to visually present quality metrics for sites and providers. The robust measurement infrastructure supports the implementation of VA-EQuIP to provide VA sites and endoscopists with bi-annual audit and feedback of colonoscopy quality. In addition, it offers individual provider benchmarking to local and national performance, as well as collaborative learning sessions moderated by national experts in colonoscopy training and quality. Future efforts also will focus on the identification of low-performing providers, and their subsequent training.
As of March 2023, 73 sites and 528 providers were enrolled in VA-EQuIP. In addition,
VA-EQuIP is now the largest colonoscopy quality assurance program in the US and has been implemented across the national VA healthcare system. The program is driving efforts to ensure every Veteran is receiving maximal benefit and high-quality colorectal cancer screening and surveillance.
Colonoscopy quality improvements have tremendous potential to impact healthcare for Veterans by reducing the risk for CRC incidence and mortality. This study on the implementation and impact of these key quality metrics also supports VA’s learning health system.
HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VHA National Gastroenterology Program, and the VA Colonoscopy Cohort.
Gawron A, Lawrence P, Millar M, et al. A nationwide survey and needs assessment of Colonoscopy Quality Assurance Programs in the VA. Federal Practitioner. 2018 Mar;35(3):26–32.
Gawron A, McKee G, Dominitz J, et al. Validation of the new VA pathology database for reporting colonoscopy associated colorectal adenoma and adenocarcinoma detection rates for quality assurance. Gastrointestinal Endoscopy. 2022 Jun 1;95(6):AB84–5.
Kaltenbach T, Gawron A, Meyer C, et al. Adenoma detection rate (ADR) irrespective of indication Is comparable to screening ADR: Implications for quality monitoring. Clinical Gastroenterology and Hepatology. 2021 Sep;19(9):1883-1889.e1.
