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2023 HSR&D/QUERI National Conference Abstract

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1103 — NATIONAL IMPLEMENTATION OF EVIDENCE-BASED COLONOSCOPY QUALITY MEASUREMENT AND REPORTING – INITIAL UPTAKE OF A LARGE OPERATIONAL PROGRAM

Lead/Presenter: Grace McKee ,  Veterans Affairs San Francisco
All Authors: Kaltenbach T (QUERI Measurement Science, VA San Francisco, University of California San Francisco), Dominitz JA (National Gastroenterology and Hepatology Program, VA Puget Sound, University of Washington) Gupta, S (VA San Diego, University of California, San Diego) Yao, Y (National Gastroenterology and Hepatology Program, VA Salt Lake City, University of Utah) McKee, G (QUERI Measurement Science, VA San Francisco, University of California, San Francisco) Bailey, T (VA Salt Lake City, University of Utah) Nguyen-Vu, T (QUERI Measurement Science, VA San Francisco, University of California, San Francisco) Helfrich, C (VA Puget Sound, University of Washington) Mog, A (National Gastroenterology and Hepatology Program, VA Puget Sound, University of Washington) Millar, M (VA Salt Lake City, University of Utah) Presson, A (University of Utah) Patterson, OV (VINCI, VA Salt Lake City, University of Utah) Whooley, M (QUERI Measurement Science, VA San Francisco, University of California, San Francisco) Gawron, AJ (National Gastroenterology and Hepatology Program, VA Salt Lake City, University of Utah)

Objectives:
High quality colonoscopy is critical for colorectal cancer (CRC). Colonoscopy quality metrics, such as adenoma detection rate (ADR), are linked to CRC incidence and mortality. Despite national guidelines recommending measurement of colonoscopy quality, most facilities have difficulty routinely monitoring metrics. Even fewer report them to providers. We previously created and validated a natural language processing and reporting system to extract and visualize colonoscopy quality metrics of ADR, cecal intubation rate, and bowel preparation quality with excellent accuracy. Our objective was to determine if our system was scalable. Herein, we report the initial implementation and baseline quality metrics of our system, the VA Endoscopy Quality Improvement Program (VA-EQuIP), in one of the largest integrated US health systems.

Methods:
We developed and implemented, within a randomized controlled trial, a national operational program that includes colonoscopy quality dashboards with benchmarking, quality toolkits, and virtual shared learning sessions on colonoscopy quality. Using a clustered randomized controlled trial with stepped wedge design over a 15 month period, we started implementation of the program to facilities in May 2021. Every 3 months, we enrolled a wedge of 15 facilities. We conducted videoconferencing introductory meetings with facility leads across the country (i.e. GI section chief or quality steward) to facilitate implementation. We shared quality performance metrics at the provider, facility and national level on a secure permissions based dashboard to 72 facilities. We measured initial stakeholder engagement, adaptation and tailoring with the program using meeting participation and dashboard access.

Results:
We generated colonoscopy quality dashboards for 75 sites with 501 providers with >25 procedures over 2 calendar years 2019-2020. The average provider annual volume was 372 (SD 325) colonoscopy procedures. The colonoscopy quality varied: Average ADR 47.5% (SD 16.4%) with a range of 10-100%; Average bowel preparation adequacy 85.2% (SD 18.1%), cecal intubation rate 89.4% (SD 16.4%). 74 (15%) providers had an ADR less than national established benchmark of 30% for men. Every enrolled facility to date (N = 72) has accessed the quality dashboard and attended virtual shared learning sessions on colonoscopy quality.

Implications:
To our knowledge, VA-EQuIP is the largest formal colonoscopy quality assurance program in the United States. We have been successful in our implementation of a secure, automated, readily accessible centralized colonoscopy quality dashboard and shared learning sessions to colonoscopy providers across the US.

Impacts:
The availability of robust quality measurement, reporting and learning systems, such as VA-EQuIP, should be a top priority of health care institutions and societies for CRC prevention. The first step to improve quality is to measure and report it to facilities and providers.