Leveraging Electronic Health Records to Measure Low-Value Screening Colonoscopy

Soroudi, Camille; Mafi, John N.; Myint, Anthony; Gardner, Juliana; Kahlon, Sartajdeep; Mongare, Margaret M.; Yang, Liu; Tseng, Chi‐Hong; Reynolds, Courtney; Nair, Vishnu; Villaflores, Chad; Cates, Reinalyn; Gupta, Reshma; Sarkisian, Catherine A.; May, Folasade P.

doi:10.1016/j.amjmed.2021.12.008

Cited by 2 publications

(2 citation statements)

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“…Building on our prior published methods, 14 15 we developed an eMeasure to identify initial EGDs in the population described above and to characterise those EGDs as either high-value or low-value, based on ICD-10 coding data available in the EHR (Epic). We defined an EGD as ‘initial’ if it was the first EGD to occur within a 3-year period.…”

Section: Methodsmentioning

confidence: 99%

“…The eMeasure builds on our experience developing a successful eMeasure of low-value colorectal cancer screening. 14 Ultimately, this new eMeasure could be implemented by clinicians across the USA to identify the cost and prevalence of low-value EGD, track the effectiveness of future QI interventions, with the potential to improve the value of care for millions of Americans. Using the eMeasure, we also sought to characterise the prevalence of low-value care for initial EGD among adults with GERD at the University of California Los Angeles (UCLA) Health, a large academic health system across multiple clinical settings.…”

Section: Introductionmentioning

confidence: 99%

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Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system

Reynolds,

Nair,

Villaflores

et al. 2023

BMJ Open Qual

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ObjectivesLow-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) ‘eMeasure’ to detect low-value EGDs.DesignRetrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019.SettingOutpatient primary care and gastroenterology clinics at a large, urban, academic health centre.ParticipantsAdult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019.Main outcome measuresEGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett’s oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure’s validity. We estimated EGD costs using Medicare physician and facility fee rates.ResultsAmong 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure’s sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients’ out-of-pocket costs.ConclusionsWe developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at the point of care.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%