Developing and Testing an Electronic Measure of Screening Colonoscopy Overuse in a Large Integrated Healthcare System

• Published in: Journal of general internal medicine : JGIM 2016-04, Vol.31 (Suppl 1), p.53-60
• Main Authors: Saini, Sameer D., Powell, Adam A., Dominitz, Jason A., Fisher, Deborah A., Francis, Joseph, Kinsinger, Linda, Pittman, Kathleen S., Schoenfeld, Philip, Moser, Stephanie E., Vijan, Sandeep, Kerr, Eve A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cancer screening; Colon; Colonoscopy; Colonoscopy - methods; Colonoscopy - trends; Colorectal cancer; Colorectal carcinoma; Cross-Sectional Studies; Delivery of Health Care, Integrated - methods; Delivery of Health Care, Integrated - trends; Diagnostic systems; Early Detection of Cancer - methods; Early Detection of Cancer - trends; Electronic Health Records - trends; Female; Health care; Humans; Internal Medicine; Male; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Occupational health; Original Research; United States; United States Department of Veterans Affairs - trends; Veterans; Veterans Health - trends
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-015-3569-y

ABSTRACT BACKGROUND Most existing performance measures focus on underuse of care, but there is growing interest in identifying and reducing overuse. OBJECTIVE We aimed to develop a valid and reliable electronic performance measure of overuse of screening colonoscopy in the Veterans Affairs Health Care System (VA), and to quantify overuse in VA. DESIGN This was a cross-sectional study with multiple cross-sections. SUBJECTS U.S. Veterans who underwent screening colonoscopy between 2011 and 2013. MAIN MEASURES Overuse of screening colonoscopy, using a validated electronic measure developed by an expert workgroup. KEY RESULTS Compared to results obtained from manual record review, the electronic measure was highly specific (97 %) for overuse, but not sensitive (20 %). After exclusion of diagnostic and high-risk screening or surveillance procedures, the validated electronic measure identified 88,754 average-risk screening colonoscopies performed in VA during 2013. Of these, 20,530 (23 %) met the definition for probable (17 %) or possible (6 %) overuse. Substantial variation in colonoscopy overuse was noted between Veterans Integrated Care Networks (VISNs) and between facilities, with a nearly twofold difference between the maximum and minimum rates of overuse at the VISN level and a nearly eightfold difference at the facility level. Overuse at the VISN and facility level was relatively stable over time. CONCLUSIONS Overuse of screening colonoscopy can be measured reliably and with high specificity using electronic data, and is common in a large integrated healthcare system. Overuse measures, such as those we have specified through a consensus workgroup process, could be combined with underuse measures to improve the appropriateness of colorectal cancer screening.