The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

Détails

ID Serval
serval:BIB_900B408C0796
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings
Périodique
Medical care
Auteur(s)
Lamiraud Karine, Holly Alberto, Burnand Bernard, Juillerat Pascal, Wietlisbach Vincent, Froelich Florian, Gonvers Jean-Jacques, Vader John-Paul
ISSN
1537-1948[electronic]
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
48
Numéro
2
Pages
101-109
Langue
anglais
Notes
http://gateway.ovid.com/ovidweb.cgi?T=JS&MODE=ovid&PAGE=fulltext&D=ovft&AN=00005650-201002000-00004
Résumé
BACKGROUND: Previous published studies have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of nonmedical factors (ie, embodied in health care system design) as possible contributors to variations in colonoscopy performance. METHODS: Patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers in 11 western countries were used. Variability was captured through 2 performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables, using a multilevel 2-equation system. RESULTS: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and longer withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and so had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and longer withdrawal times. CONCLUSIONS: Our results suggest that gatekeeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight the fact that longer withdrawal times do not necessarily indicate higher quality in teaching centers.
Pubmed
Web of science
Création de la notice
26/01/2010 16:19
Dernière modification de la notice
03/03/2018 19:23
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