Outcomes assessment in gastrointestinal endoscopy
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| Format: | Buch |
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| Sprache: | English |
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Philadelphia [u.a.]
Saunders
1999
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| Schriftenreihe: | Gastrointestinal endoscopy clinics of North America
9,4 |
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Datensatz im Suchindex
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| adam_text | OUTCOMES ASSESSMENT DM GASTROINTESTINAL ENDOSCOPY
CONTENTS
Foreword xi
Charles J. Lightdale
Preface xiii
John F. Johanson and Martin L. Freeman
Importance of Outcomes Research in Endoscopic
Practice 559
John F. Johanson
The field of outcomes research has emerged in response to rising health
care costs and the continued scarcity of resources. This field concerns itself
with identifying the most effective and efficient use of finite resources
and is a monitoring system to ensure that quality is maintained. This
commitment to quality, however, must extend to the level of the individual
endoscopist to ensure that patients interests are maintained. If physicians
are not actively involved in data collection and measurement to improve
the quality and value of their work, someone else undoubtedly will. Because
quality assessment and the accountability revolution in health care has
public support, individual practitioners and entire specialties increasingly
will need to provide routine outcomes data.
Overview of Tools for Outcomes Assessment 565
Colleen M. Schmitt
Tools for outcomes research can encompass local concepts such as a compu¬
terized database of endoscopy reports, or broader concepts such as a na¬
tional database capturing similar data. Outcomes research may be defined
by the investigator, but its results are important to the consumer, be it the
patient or the payor. Databases, common to many endoscopy units, become
outcomes research tools when the data are scrutinized for outcomes such
GASTROINTESTINAL ENDOSCOPY
CLINICS OF NORTH AMERICA
VOLUME 9 • NUMBER 4 • OCTOBER 1999 V
as quality of life, mortality, and interventions that may improve cost
effective care. Enhanced knowledge of methods to capture these data will
benefit all gastrointestinal endoscopists.
Economic Analysis of Endoscopic Procedures 573
Dawn Provenzale
Economic analysis is becoming an important tool for the evaluation of new
technologies. In this era of rapidly rising health care costs, we are required
to demonstrate that our procedures are effective and cost efficient. This
article provides a glossary of terms for the evaluation and performance of
an economic analysis and outlines the steps for performing an economic
evaluation of an endoscopic procedure. The reader is provided with the
skills to critically evaluate economic analyses of endoscopic technologies,
and to determine their relevance to their practice.
Endoscopic Databases and Outcomes Research 587
Glenn M. Eisen
Endoscopic databases may take several shapes and forms. They are impor¬
tant tools for the assessment of patient centered outcomes. This article
discusses the obstacles to data collection and the importance of a standard
endoscopic terminology and content. The strengths and shortcomings of
endoscopic databases are also described. Finally, the reader is apprised of
the databases currently available for the clinical practitioner.
Quality Assurance in the Endoscopy Unit: An Emphasis
on Outcomes 595
Russell D. Brown and Jay L. Goldstein
This article identifies and reviews key elements of quality improvement
programs for an endoscopy unit. The new paradigm of quality improve¬
ment seeks to improve all performance, and does not simply focus on
the low outliers as in the traditional quality assurance program. The
organization and key elements are emphasized, including selection of key
indicators and methodologies for the development of standards of practice
and benchmarks. Examples of quality improvement initiatives are dis¬
cussed, demonstrating their value in improved patient care and the process
or function of an endoscopy unit.
Procedure Specific Outcomes Assessment for
Esophagogastroduodenoscopy 609
Colleen M. Schmitt
For many, if not most, of our new technology applications, it is time for a
broadening of study goals to include clinical endpoints such as health
related quality of life. Similarly, effectiveness studies to evaluate the applica¬
tion of known and new technology in every day practice, are needed.
Establishing uniform definitions and terminology for important constructs
such as comorbidity, disease severity, endoscopic findings, and complica
Vi CONTENTS
tions must be undertaken in order to ensure accuracy of conclusions. Critical
evaluation of how we deliver care to patients with upper GI diseases
requiring endoscopy, must proceed with the knowledge that medical care
is a process, and within that process, is the means to deliver care of ever
increasing quality and efficiency. In this context, this article provides a
brief overview of our current knowledge and potential of outcomes research
in upper GI endoscopy.
Procedure Specific Outcomes Assessment for
Colonoscopy 625
John F. Johanson
Since its origin, much of the improvement in colonoscopy has been related
to technologic advancements in the endoscope itself. The pace of technologic
improvement, however, has slowed and improvements affecting colonos¬
copy are occurring in new areas; one of which is patient outcomes. Using
this analogy of macro and micro outcomes research (quality assessment),
this article highlights key outcomes research and quality assessment issues
as they apply to colonoscopy.
Procedure Specific Outcomes Assessment for Endoscopic
Retrograde Cholangiopancreatography 639
Martin L. Freeman
The outcome of therapeutic ERCP, or any other medical intervention, is a
balance between technical success, avoidance of complications, and efficacy
of the procedure in achieving its intended therapeutic goal. There is an
increasing need for objective assessment of such outcomes to help physi¬
cians improve their quality of care, to enable patients to better select health
care providers, and increasingly, because health care providers are demand¬
ing some kind of objective assessment. In this article, the author reviews
methods for quantification of the three principal components of ERCP
outcomes, and provides suggestions for data collection to facilitate quality
assessment in clinical practice.
Procedure Specific Outcomes Assessment for Endoscopic
Ultrasonography 649
Amitabh Chak and Gregory S. Cooper
Endosonography (EUS)isa relative newcomer to the field of gastrointestinal
endoscopy. Nevertheless, two prospective studies with similar results have
shown that EUS leads to a change in management in roughly two thirds
of patients in whom it is performed, with many of these changes being to
less invasive or less expensive management. Preliminary investigations on
the use of catheter probes for performing EUS have shown similar effects.
Specific investigations on the effect of EUS on the outcomes of patients
with submucosal tumors, esophageal cancers, pancreatic cancers, and rectal
cancers need to be performed. Selective studies have demonstrated EUS to
be cost effective for the management of submucosal tumors and ampullary
tumors. The complication rate of EUS appears to be comparable to that of
upper endoscopy. There is little or no information regarding training in
EUS, practice variation, or affect of EUS on quality of life.
CONTENTS Vii
Disease Specific Outcomes Assessment for
Gastroesophageal Reflux Disease 657
David Lieberman
Endoscopy is commonly performed to evaluate patients with symptoms of
gastroesophageal reflux disease (GERD). This review focuses on outcomes
related to endoscopy in GERD. There is clear evidence that patients with
GERD who have dysphagia are likely to benefit from endoscopy. In the
vast majority of patients without dysphagia, the benefits of endoscopy are
less certain and require further study.
Disease Specific Outcomes Assessment for
Gastrointestinal Bleeding 665
Ian M. Gralnek
Over the past twenty years, outcomes research has emerged as a methodol¬
ogy to systematically evaluate medical practice and outcomes of care. The
assessment of outcomes in clinical practice can improve the quality of care
delivered to patients. More specifically, improved quality can be realized
by identifying endoscopic practices that are cost efficient, by reducing the
variability of endoscopic interventions, and by eliminating those endoscopic
interventions that appear to be ineffective. The aims of this article are to pro¬
vide practical information to the practicing endoscopist on which outcomes
are important to measure in patients with gastrointestinal hemorrhag, and
to detail methods of how to accomplish this.
Disease Specific Outcomes Assessment for Dyspepsia 671
Michael J. Shaw and Michael K. Newcomer
Dyspepsia has a high prevalence in the general population with significant
health care costs. It remains one of the most common indications for upper
endoscopy. This article reviews the role of endoscopy in the management
of dyspepsia. In addition, this article reviews the published series of endo¬
scopic findings in subjects with dyspepsia and evidence of the effectiveness
of endoscopy in dyspepsia management. This article concludes with direc¬
tions in endoscopic research and development for dyspepsia.
Disease Specific Outcomes Assessment for Irritable
Bowel Syndrome 685
Jamshid S. Kalantar and G. Richard Locke III
Irritable bowel syndrome (IBS) is a common disorder that results in many
physician visits and health care costs. Because IBS is so common, patients
presenting with abdominal pain, constipation, and diarrhea must be evalu¬
ated as cost effectively as possible. Little data exist to guide the clinician
on how to best use endoscopy in IBS. By appropriately recognizing the
cardinal symptoms of IBS, investigation can be minimized.
Viii CONTENTS
Disease Specific Outcomes Assessment for Diagnosis of
Colorectal Neoplasia: From Clinical Trials to
Community Practice 697
Douglas K. Rex and Reid M. Ness
The value of monitoring the performance of diagnostic testing in clinical
practice is emphasized through data showing that experts with apparently
equal training have substantially different sensitivity for cancer and polyp
detection when performing colonic imaging studies. The authors discuss
the effects of variation in study population, testing methodology, and exper¬
tise of examiners on the outcomes of diagnostic tests for colorectal cancer.
Disease Specific Outcomes Assessment for Common
Bile Duct Stones 705
Anand V. Sahai
Clinicians often manage patients with suspected bile duct stones. Research
has focused on assessing the accuracy of diagnostic alternatives to endo
scopic retrograde cholangiography or on establishing predictors for stones.
Studies using costs and quality of life as primary outcomes are rare. This
may be caused in part by specific challenges inherent to outcomes research
in the field of gastrointestinal endoscopy. It is unlikely that one strategy
will be suitable for all; however, once a primary outcome is chosen, knowing
what variables most affect this outcome should help clinicians objectively
tailor the optimal strategy for their needs. The most important variable
may be the risk of symptoms caused by untreated stones. There may be a
substantial group of patients who are best managed expectantly (with no
bile duct imaging). It may therefore, be useful to obtain better prospective
data on the natural history of choledocholithiasis.
Disease Specific Outcomes Assessment for Chronic
Pancreatitis 717
Glenn M. Eisen and Richard Zubarik
Outcomes assessment for individuals with chronic pancreatitis is a rela¬
tively new area of research. It is particularly important because of the lack
of validated clinical assessment tools for those with this disease process.
This article critically evaluates the current medical, endoscopic, and surgical
interventions available for patient management.
Cumulative Index 731
Subscription Information Inside back cover
CONTENTS ix
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| spellingShingle | Outcomes assessment in gastrointestinal endoscopy Gastrointestinal endoscopy clinics of North America Endoscopie gastrointestinale Maladie de l'appareil digestif Endoscopy Endoscopy, Gastrointestinal Gastroenterology Gastrointestinal Diseases diagnosis Treatment Outcome Evaluation (DE-588)4071034-8 gnd Minimal-invasive Chirurgie (DE-588)4327907-7 gnd Therapieerfolg (DE-588)4126073-9 gnd |
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| title | Outcomes assessment in gastrointestinal endoscopy |
| title_auth | Outcomes assessment in gastrointestinal endoscopy |
| title_exact_search | Outcomes assessment in gastrointestinal endoscopy |
| title_full | Outcomes assessment in gastrointestinal endoscopy John F. Johanson ..., guest ed. |
| title_fullStr | Outcomes assessment in gastrointestinal endoscopy John F. Johanson ..., guest ed. |
| title_full_unstemmed | Outcomes assessment in gastrointestinal endoscopy John F. Johanson ..., guest ed. |
| title_short | Outcomes assessment in gastrointestinal endoscopy |
| title_sort | outcomes assessment in gastrointestinal endoscopy |
| topic | Endoscopie gastrointestinale Maladie de l'appareil digestif Endoscopy Endoscopy, Gastrointestinal Gastroenterology Gastrointestinal Diseases diagnosis Treatment Outcome Evaluation (DE-588)4071034-8 gnd Minimal-invasive Chirurgie (DE-588)4327907-7 gnd Therapieerfolg (DE-588)4126073-9 gnd |
| topic_facet | Endoscopie gastrointestinale Maladie de l'appareil digestif Endoscopy Endoscopy, Gastrointestinal Gastroenterology Gastrointestinal Diseases diagnosis Treatment Outcome Evaluation Minimal-invasive Chirurgie Therapieerfolg Aufsatzsammlung |
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