Researchers have found important variation in quality of colonoscopies among outpatient facilities.
The researchers at the Center for Outcomes Research and Evaluation (CORE) at Yale–New Haven Hospital, New Haven, CT, developed an outcome measure by estimating risk-standardized rates of unplanned hospital visits within seven days of colonoscopy. The research was published in the January 2016 issue of Gastroenterology.
They used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8,140 facilities) from patients 65 years of age or older. They estimated the risk of unplanned hospital visits (for example, emergency department visits, observation stays, and inpatient admissions) within seven days of colonoscopies. They estimated facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from four states containing 100% of colonoscopies per facility.
Outpatient colonoscopies were followed by 5,412 unplanned hospital visits within seven days (16.3/1,000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits, the researchers said. A history of fluid and electrolyte imbalance, psychiatric disorders, and, in the absence of prior arrhythmia, increasing age past 65 year were most strongly linked with unplanned hospital visits.
The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation. Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and ranged from 16.1/1000 in the Northeast to 17.2/1000 in the Midwest. (To see a copy of the study, go to bit.ly/1ntjHA4.)
