CAG Quality Program in Endoscopy (QP-E: Colonoscopy) Point-of-Care Practice Audit

Transcription

1 CAG Quality Program in Endoscopy (QP-E: Colonoscopy) Point-of-Care Practice Audit David Armstrong Chair, CAG Endoscopy Committee Associate Professor, McMaster University Ottawa, Ontario 26 th September 2011

2 Conflicts of Interest: David Armstrong Company Abbott Laboratories AstraZeneca Canada Axcan Pharma Boston Scientific ConMed Canada Cook Canada Merck (Schering Plough) Olympus Canada Pentax Medical Shire Canada Takeda Canada Warner Chilcott\ XenoPort Inc. Relationship Consulting, Advisory, Speaking, Research Support, Educational Event Consulting, Advisory, Speaking, Research Support, Educational Event Speaking, Educational Event Sponsorship Educational Event Sponsorship Educational Event Sponsorship Educational Event Sponsorship Consulting, Advisory, Research Support, Educational Event Sponsorship Advisory, Educational Event Sponsorship Consulting, Advisory, Research Support, Educational Event Sponsorship Advisory, Educational Event Sponsorship Consulting, Advisory, Speaking, Research Support, Educational Event Speaking, Research Support, Educational Event Sponsorship Consulting, Advisory, Research Support I shall not be discussing any unapproved or off-label use of products

3 Quality in Endoscopy Goal Documentation of Continuing Professional Development (CPD) activities is required for all specialists in Canada Practice Audit is the core of CPD Practice Audits can be difficult and time consuming: To conduct To compare with peer practice

4 Practice Review and Appraisal Activities that assist specialists to review their practice Royal College of Physicians & Surgeons of Canada Maintenance of Certification Framework of educational (CPD) options Fellows required to earn 400 credits during 5 years of part-time or full-time practice (clinical/laboratory, administration, education, research) by participating in educational activities of their choice. Section 5 Examples of CPD Activities Assignment of Credits Practice audits & patient surveys Institution audits, incident reports, utilization studies Other care appraisal studies (based on practices of peers) 2 credits per hour (No maximum)

5 Aims To develop and evaluate a novel, accredited, practice audit program for gastroenterologists To provide gastroenterologists with a practicable means to: Assess their own practice Compare their practice with their peers Identify learning needs and opportunities To develop a platform suitable for point-of-care audit for different practice areas

6 Design Data collection: At point of care Electronic easy to use, store & retrieve Independent of EMR / Hospital IT No patient identifiers Provide feedback Anonymous Individual & Peer data Relevant to GI practice: GI Endoscopy

7 Design Change in Practice Point-of-Care Data Input Data Transmission Reflection on Practice Website Database Data Review Website Presentation Data Analysis

8 Practice Audit in Gastro- Enterology (PAGE) PAGE Program has evaluated: Upper Endoscopy Colonoscopy A Week in the Life of a Gastroenterologist Wait Times

9 PAGE Program: Summary Upper Endoscopy Time period months Colonoscopy months Wait Times months Participants Gastroenterologists 79% 80% 94% Audits Mean / participant Completed > 90% 69% 86% N/A Armstrong D et al. Can J Gastroenterol 2006;20:405 Armstrong D et al. Can J Gastroenterol 2008;22:155 Leddin D et al. Can J Gastroenterol 2008;22:405

10 PAGE Program: Lessons Data collection: Simple One screen per question (no scrolling ) Data readily available Rapid cannot disrupt clinical care Data transmission: Safe & secure Feedback: Prompt and relevant Credits: Available Armstrong D et al. Can J Gastroenterol 2006;20:405 Armstrong D et al. Can J Gastroenterol 2008;22:155 Leddin D et al. Can J Gastroenterol 2008;22:405

11 CAG Quality in Gastroenterology Endoscopy Unit Recognition Program

12 Quality Program Endoscopy Colonoscopy Audit Smart phone for each endoscopy room Data entry during procedure Automatic download on completion Data download to website Data integrity verified Data analysed for clinical questions Individual & aggregate data displayed at secure website for personal review Review activity certified for CPD credits Armstrong D et al. Can J Gastroenterol 2011;25:13-20

13 Quality Program Endoscopy Colonoscopy Audit Quality & Safety Indicators Recorded* Wait times Indication (Reason) Time since last colonoscopy Patient age Procedure time (start, cecum, end) Preparation quality (Ottawa) Biopsy Polypectomy Immediate complications Sedation used Armstrong D et al. Can J Gastroenterol 2011;25:13-20 *Faigel DO, Cotton PB. OMED Endoscopy 2009;41:

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15 Quality Program Endoscopy Extent of Colonoscopy

16 CAG Colonoscopy Audit Polyp Removal vs. Withdrawal Time Polyp removal (% colonoscopies) Polyp removal rate (%) Spearman Correlation Coefficient = p = Mean withdrawal time: no polyp removal (min) Armstrong D et al. Can J Gastroenterol 2011;25:13-20

17 Quality Program Endoscopy Colonoscopy Audit Credits Website / CAG e-portal permits: Review of personal data Review of peer data Access to relevant published evidence Documentation of time spent reviewing data Section 3: 3 credits / hour

18 Quality Program - Endoscopy Current Projects Colonoscopy Audit Evaluation (Royal College) Pre-intervention audit (50 physicians, 30 procedures) Education Program - Polyp detection and removal Post-intervention audit Resident Practice Audit (Upper Endoscopy & Colonoscopy) Pilot program ( ) for GI residents Record all procedures basis for training, evaluation & credentialing

19 Quality Program - Endoscopy Future Development Collaboration with other (sub)specialty societies Canadian Association of General Surgeons (CAGS) Canadian Society for GI Nurses and Assistants (CSGNA) Maintain integration with overall clinical care GRS-Canada Endoscopy Unit Quality Independent verification of data e.g. Nursing Detailed, personalised data analysis at website Targeted educational programs Develop for needs assessments & practice guidelines Develop for other clinical areas, specialties & MAINPORT

20 Quality Program Endoscopy; PAGE Program: Thanks Don MacIntosh Richard Hunt Roger Hollingworth Michael Gould Rob Enns Catherine Dubé Rob Bridges Alan Barkun David Armstrong Wendy Smith Paul Sinclair Stuart Gittens Tara Gardiner Sandra Daniels Ying Chen CAG CPAC AstraZeneca

21 Thank you on behalf of CAG