Quality measurement and improvement in upper endoscopy

One consequence of recent health care reform efforts has been an increasing focus on defining and delivering high-quality care. Esophagogastroduodenoscopy (EGD) is a fundamental procedure for endoscopists and quality indicators for measurement have been proposed. These indicators are classified temporally as preprocedural, intraprocedural, and postprocedural. Although some indicators are evidence based, many are derived from expert consensus and may require further validation. An ideal quality indicator is easy to measure at the time of service, correlates well with patient outcome and experience, and has enough variation in practice to allow differentiation between good and poor performers. Among the many proposed quality measurements, it remains uncertain which best meet such criteria. Beyond compliance with reporting quality indicators for EGD, successful endoscopy practices will embrace quality improvement initiatives that collect, organize, and analyze their performance data to improve patient outcomes and the patient endoscopic experience. In recognition of these forthcoming changes, organizations have developed national repositories to assist endoscopy groups in this effort. These initiatives to first gauge and then improve the quality of EGD must lead in parallel to the development of standardized criteria for competency that can be adopted by all programs in which endoscopy is taught, regardless of specialty.