Quality measurement and improvement in advanced procedures

Quality measurement and improvement appear feasible for advanced endoscopy, but much work remains. Although many areas need refinement, the widespread use, reporting, and publicizing of already known metrics must be achieved as quickly as possible. The use of such metrics will undoubtedly begin with individuals who are already confident their recorded metrics will look favorable, and others will then follow. Quality networks, such as the one developed for endoscopic retrograde cholangiopancreatography (ERCP), prove to be invaluable for assessing the feasibility of measurement, community (including international) variation, factors associated with improved performance, and perhaps even outcome measurement using surrogates. Delayed events and outcomes remain difficult to measure in such networks. Hopefully, the increased focus on quality will allow such metrics to be developed, collected, benchmarked, and endorsed much more quickly for newer, more advanced endoscopy techniques than they were for ERCP and EUS; these endoscopic tools have been around for about 40 and 30 years, respectively, yet are still young in terms of metric development. Although the volume is lower for advanced endoscopy, the stakes are higher, and as such, quality metric development and implementation are just as important as in routine endoscopy; however, because of the procedure complexity, the wide spectrum of indications and maneuvers, and advanced endoscopist attitudes, reaching consensus and enforcement may be more difficult. The public and the practice need such metrics, however, and we must move forward.