Quality Improvement in Gastroenterology: A Systematic Review of Practical Interventions for Clinicians
- 395 Downloads
Quality improvement (QI) identifies practical methods to improve patient care; however, it is not always widely known which QI methods are successful. We sought to create a primer of QI in gastroenterology for the practicing clinician.
We performed a systematic review of QI literature in gastroenterology. We included search terms for inflammatory bowel disease, irritable bowel syndrome, celiac disease, gastroesophageal reflux disease, pancreatitis, liver disease, colorectal cancer screening, endoscopy, and gastrointestinal bleeding. We used general search terms for QI as well as specific terms to capture established quality metrics for each GI disease area.
We found 33 studies that met our definitions for QI. There were 17 studies of endoscopy including screening colonoscopy, six on liver disease, four on IBD, two on GERD, three on GI bleeding, and one on celiac disease. Education was the most common intervention, although most successful studies combined education with another intervention. Other effective interventions included retraining sessions to reach ADR goals in colonoscopy, nursing protocols to increase HCC screening, and EMR decision support tools to prompt reassessment of PPI therapy. Many studies showed improved compliance to metrics, but few were able to show differences in length of stay, readmissions, or mortality.
Our review of quality improvement literature in gastroenterology revealed common themes of successful programs: Education was frequently used but often insufficient, the EMR may be underutilized in guiding decision making, and patient-reported outcomes were infrequently assessed. Further research may be needed to compare QI strategies directly.
KeywordsQuality improvement Health services Gastroenterology Delivery of health care
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.OECD Health Statistics 2017. June 30th, 2017. Organization for Economic Co-operation and Development. http://www.oecd.org/els/health-systems/health-data.htm. Accessed August, 15, 2017.
- 3.MacDorman MF, Mathews TJ, Mohangoo AD et al. International comparisons of infant mortality and related factors: United States and Europe. Natl Cent Health Stat. 2014;63(5):1–6. Google Scholar
- 4.Robeznieks A. US has the highest maternal death rate among developed countries. Modern Healthcare, May 6th, 2015. http://www.modernhealthcare.com/article/20150506/NEWS/150509941. Accessed August 15, 2017.
- 5.Xu J, Murphy SL, Kochanek KD et al. Mortality in the United States, 2015. NCHS Data Brief. 2016; No. 267.Google Scholar
- 6.Readmissions Reduction Program. Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Accessed August 15, 2017.
- 13.Choosing Wisely: An Initiative of the ABIM Foundation. American Gastroenterology Association. http://www.choosingwisely.org/societies/american-gastroenterological-association/. Accessed January 5, 2018.
- 14.Physician Quality Reporting System 2015. American Gastroenterology Association. https://www.gastro.org/practice/quality-initiatives/performance-measures/400-1708901-MHC-AGA_PQRS-IBD-Flashcard.pdf. Accessed January 5, 2018.
- 44.2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy. Agency for Healthcare Research and Quality. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/priorities.html. Accessed January 5, 2018.