Why Choose AGA

Quality Assurance Program

 

Measurement of quality in outpatient colonoscopy has been a priority at Asheville Gastroenterology Associates since 2004.  We believe our quality assurance program is unique among gastroenterology practices in the extent of North Carolina and represents leadership on a national level.  Our practice utilizes a computer database to capture the important outcomes and a quality assurance committee that reviews the data and provides feedback to the individual physicians.  This ongoing process helps insure the highest quality of care for endoscopy at The Endoscopy Center.

 The ASGE/ACG task force on quality in endoscopy published a recent paper highlighting quality indicators for colonoscopy.  It was recommended that quality measures be used as a part of continuous quality improvement process for all colonoscopy practices.  

 

Measurement of Quality Outcomes

We recently developed a new expanded database to capture important quality measures for outpatient colonoscopy.  Quality indicators that are currently measured on all outpatient colonoscopies include:

  • Preparation quality

  • Rate of completion of colonoscopy

  • Adenoma polyp detection rate

  • Colonoscopic withdrawal time (measured from the cecum)

  • Complication rate

 
1. Preparation Quality - Studies have found that the ability to detect polyps is partially dependant on the quality of the colon preparation.  We currently measure preparation quality using a standardized grading scale the defines the preparation as excellent, good, fair or poor.  A copy of the global preparation assessment with description and photographs is in all the endoscopy rooms to allow for objective grading of the preparation.  The goal for the unit is to have greater than 95% colon preparations either excellent or good.


2. Colonoscopy Completion Rate -  Ability to examine the entire colon including the cecum is important for quality colon cancer screening program.  The task force on quality in endoscopy recommended a greater than 95% cecal intubation rate for screening cases.  We define cecal intubation as passage of the colonoscopy tip to a point proximal to the ileocecal valve with adequate photo documentation of the cecum and appendiceal orfice.  The database will capture the rate to which individual physicians reach the cecum to insure meeting the benchmark standards.


3. Adenoma Polyp Detection Rate - The ability to identify and remove adenomatous polyps is of key importance in the prevention of colon cancer.  The prevalence of colon polyps is dependent on the age, gender and other risk factors of the screened population.  Review of our adenoma detection rates for screening colonoscopy since 2004 has revealed polyp detection rates between 30 and 35%.  We will continue to measure the individual endoscopists detection rate to ensure quality exams. 


4. Colonoscopy Withdrawal Time -  A recent study highlighted the importance of spending adequate time withdrawing the scope from the cecum and inspecting the colon mucosa to maximize polyp detection.  Expert opinion has recommended a withdrawal time from the cecum to be between 6 and 10 minutes.  Our current database will measure the withdrawal time from the cecum on all patients to ensure the endoscopists cases are within the recommended parameters. 


5. Complication Rate - We currently measure all complications including perforation, post polypectomy bleeding and complication related to the use of conscious sedation.  These will be reported per physician and an aggregate for the entire endoscopy unite to ensure our complication rates remain low and within national standards.

For Patients

ASHEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.