Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits

摘要: Background & Aims Colonoscopy is a common procedure, yet little known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days colonoscopy. Methods used 20% sample 2010 Medicare claims (331,880 colonoscopies performed at 8140 facilities) from patients ≥65 years or older, and patient-level logistic regression model estimate the risk (ie, emergency department visits, observation stays, inpatient admissions) then variables hierarchical facility using data Healthcare Cost Utilization Project (325,811 992 facilities), 4 states containing 100% per facility. Results Outpatient were followed 5412 (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, perforation most causes visits. Fifteen independently associated with (c = 0.67). A history fluid electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29−1.58), psychiatric disorders (OR = 1.34; CI: 1.22−1.46), and, absence prior arrhythmia, increasing age past 65 (aged >85 vs 65−69 years: OR = 1.87; 1.54−2.28) strongly associated. The calculated showed significant variation (median 12.3/1000; 5th−95th percentile, 10.5−14.6/1000). Median comparable between ambulatory surgery centers departments (each was 10.2/1000), ranged 16.1/1000 Northeast 17.2/1000 Midwest. Conclusions risk-adjusted quality, which shows important This can make transparent extent require follow-up care, help inform patient choices, assist quality-improvement efforts.