The researchers assessed the quality of care in Barrett's esophagus by evaluating the process of care and adherence to accepted standards of practice.
They reported their finding in the American Journal of Gastroenterology.
Explicit process-of-care criteria were developed, using a systematic literature review and expert opinion in four domains of care. These were the quality of biopsy methods, the adequacy in identifying endoscopic landmarks, endoscopist-pathologist communication, and pathological interpretation and reporting.
All endoscopy and pathology reports of Barrett's patients at two institutions were reviewed from 1994 to 1997. An academic medical center (n = 237) with staff endoscopists and an academically affiliated community hospital (n = 100) with private-practice endoscopists were analyzed.
|Improvement needed in quality of biopsy methods in Barrett's.
|American Journal of Gastroenterology|
Physicians showed the highest adherence to accepted standards of care in the 'adequacy of identifying landmarks' and 'endoscopist-pathologist communication' domains. They demonstrated 70% or more adherence rate in most criteria.
Conversely, physicians demonstrated the poorest adherence with the 'quality of biopsy methods' and 'pathologist interpretation and reporting' domains. Here the adherence rates were frequently less than 60%. Biopsies were taken in the presence of visible esophagitis 35% of the time.
The team found that performance on several of the quality indicators varied significantly by the practice setting.
Researcher J. J. Ofman, of the Cedars-Sinai Medical Center, said on behalf of the group, "We have identified several opportunities for quality improvement efforts. In every domain, there is room for improvement, particularly in the quality of biopsy methods."
"As initiatives to screen the large population of gastro-esophageal reflux disease patients for Barrett's may be imminent, the time is now to define the critical process-of-care measures to minimize the risk of over-diagnosis and inadequate endoscopic surveillance," it was concluded.