Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use (NQF ACP-017-10)

eMeasure Name Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use eMeasure Id 0B663DA8-F23E-4DBF-8455-E2F42CDB8F97
Version number 1 eMeasure Set Id 1F8BFD0E-B69C-48AE-A901-7575EE908DC4
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by Pending endorsement by National Quality Forum
Description Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior colonic polyp in previous colonoscopy findings who had a follow-up interval of 3 or more years since their last colonoscopy documented in the colonoscopy report
Copyright
© 2010 American Medical Association  and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Colonoscopy is the recommended method of surveillance after the removal of adenomatous polyps because it has been shown to significantly reduce subsequent Colorectal Cancer incidence. The timing of follow-up colonoscopy should be tailored to the number, size, and pathologic findings of the adenomatous polyps removed. The time interval for the development of malignant changes in adenomatous polyps is estimated at 5 to 25 years (ICSI, 2006). A randomized controlled trial of 699 patients showed that after newly diagnosed adenomatous polyps have been removed by colonoscopy, follow-up colonoscopy at 3 years detects important colonic lesions as effectively as follow-up colonoscopy at both 1 and 3 years (ICSI, 2006). Performing colonoscopy too often not only increases patients' exposure to procedural harm, but also drains limited resources that could be more effectively used to adequately screen those in need. Recent evidence from 4 surveys indicated that postpolypectomy surveillance colonoscopy in the United States is frequently performed at intervals that are shorter than those recommended in guidelines (Rex et al, 2006). Some endoscopists in these studies performed colonoscopy in patients with only small hyperplastic polyps or a single tubular adenoma at 1 year. These surveys underscore the importance of measuring intervals between examinations in continuous quality improvement programs.
Clinical Recommendation Statement
Patients with 1 to 2 small (1 cm) tubular adenomas with only low-grade dysplasia should undergo follow-up colonoscopy no earlier than 5 years later. Patients with advanced adenomatous lesions or >3 adenomas should have repeat colonoscopy in 3 years as long as all visualized polyps were completely removed, the colonoscopy was completed up to the cecum, and the colonic preparation was adequate. A shorter interval of follow-up is recommended in those patients with numerous adenomatous (>10) polyps and in those in whom the colonoscopy was incomplete or the preparation was inadequate. After a surveillance colonoscopy has normal results, repeat examinations should be done at 5-year intervals. Patients with large, sessile adenomatous lesions removed in a piecemeal fashion should have a repeat examination within 2 to 6 months to exclude and remove and remnant polypoid tissue (Davila et al, 2006).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Institute for Clinical Systems Improvement (ICSI). Colorectal cancer screening. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jun. 50 p.
Reference
Rex, D.K., M.D., J.L. Petrini, M.D., T.H. Baron, M.D., A. Chak, M.D., J. Cohen, M.D., S.E. Deal, M.D., B. Hoffman, M.D., B.C. Jacobson, M.D., M.P.H., K. Mergener, M.D., Ph.D., B.T. Petersen, M.D., M.A. Safdi, M.D., D.O. Faigel, M.D., ASGE Co-Chair, I.M. Pike, M.D., ACG Co-Chair. ASGE/ACG Taskforce on Quality in Endoscopy. Am J Gastroenterol 2006; 101:873–885.
Reference
Davila, R, Rajan, E, Baron, T. American Society for Gastrointestinal Endoscopy. ASGE guideline: colorectal cancer screening and surveillance. Vol. 63. No.4; 2006.
Definition
Initial Patient Population(s): Patient Age: Patients aged 18 years and older before the start of the measurement period.
Diagnosis Inactive: Patient with a history of a prior colonic polyp in previous colonoscopy findings before or simultaneously to measurement period.
Diagnostic Study: Surveillance colonoscopy performed during the measurement period.
Definition
Denominator(s): All patients aged 18 years and older receiving a surveillance colonoscopy with a history of a prior colonic polyp in a previous colonoscopy.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who had an interval of 3 or more years since their last colonoscopy.
Definition
Denominator Exception(s): Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (eg, patients with high risk for colon cancer, last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or last colonoscopy found greater than 10 adenomas).
Documentation of a system reason(s) for an interval of less than 3 years since the last colonoscopy (eg, unable to locate previous colonoscopy report).
Guidance
This measure is applicable to patients with a history of colonic polyps. The measure  evaluates whether at least 3 years has passed between a prior colonoscopy and a colonoscopy performed during the measurement period.  For some patients it may be acceptable to perform a subsequent colonoscopy sooner than 3 years from the date of the prior colonoscopy.  These specified reasons are represented in the exceptions; additionally, if the physician determines the procedure should be performed sooner than 3 years, these instances are considered allowable exceptions, provided there is documentation of such reason in the patient record.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012