Rena Yadlapati1, Andrew J Gawron2, Rajesh N Keswani3, Karl Bilimoria4, Donald O Castell5, Kerry B Dunbar6, Chandra P Gyawali7, Blair A Jobe8, Philip O Katz9, David A Katzka10, Brian E Lacy11, Benson T Massey12, Joel E Richter13, Felice Schnoll-Sussman14, Stuart J Spechler6, Roger Tatum15, Marcelo F Vela16, John E Pandolfino3. 1. Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: rena.yadlapati@northwestern.edu. 2. Division of Gastroenterology, University of Utah, Salt Lake City, Utah. 3. Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 4. Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 5. Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina. 6. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center and the Dallas VA Medical Center, Dallas, Texas. 7. Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri. 8. Esophageal and Thoracic Institute, Allegheny Health Network, Pittsburgh, Pennsylvania. 9. Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, Pennsylvania. 10. Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota. 11. Division of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. 12. Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin. 13. Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida. 14. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York. 15. Department of Surgery, University of Washington, Seattle, Washington. 16. Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona.
Abstract
BACKGROUND & AIMS: Esophageal manometry is the standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of esophageal manometry result in discrepant diagnoses and unnecessary repeated procedures, and could have negative effects on patient outcomes. We need a method to benchmark the procedural quality of esophageal manometry; as such, our objective was to formally develop quality measures for the performance and interpretation of data from esophageal manometry. METHODS: We used the RAND University of California Los Angeles Appropriateness Method (RAM) to develop validated quality measures for performing and interpreting esophageal manometry. The research team identified potential quality measures through a literature search and interviews with experts. Fourteen experts in esophageal manometry ranked the proposed quality measures for appropriateness via a 2-round process on the basis of RAM. RESULTS: The experts considered a total of 29 measures; 17 were ranked as appropriate and were as follows: related to competency (2), assessment before the esophageal manometry procedure (2), the esophageal manometry procedure itself (3), and interpretation of data (10). The data interpretation measures were integrated into a single composite measure. Eight measures therefore were found to be appropriate quality measures for esophageal manometry . Five other factors also were endorsed by the experts, although these were not ranked as appropriate quality measures. CONCLUSIONS: We identified 8 formally validated quality measures for the performance and interpretation of data from esophageal manometry on the basis of RAM. These measures represent key aspects of a high-quality esophageal manometry study and should be adopted uniformly. These measures should be evaluated in clinical practice to determine how they affect patient outcomes.
BACKGROUND & AIMS: Esophageal manometry is the standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of esophageal manometry result in discrepant diagnoses and unnecessary repeated procedures, and could have negative effects on patient outcomes. We need a method to benchmark the procedural quality of esophageal manometry; as such, our objective was to formally develop quality measures for the performance and interpretation of data from esophageal manometry. METHODS: We used the RAND University of California Los Angeles Appropriateness Method (RAM) to develop validated quality measures for performing and interpreting esophageal manometry. The research team identified potential quality measures through a literature search and interviews with experts. Fourteen experts in esophageal manometry ranked the proposed quality measures for appropriateness via a 2-round process on the basis of RAM. RESULTS: The experts considered a total of 29 measures; 17 were ranked as appropriate and were as follows: related to competency (2), assessment before the esophageal manometry procedure (2), the esophageal manometry procedure itself (3), and interpretation of data (10). The data interpretation measures were integrated into a single composite measure. Eight measures therefore were found to be appropriate quality measures for esophageal manometry . Five other factors also were endorsed by the experts, although these were not ranked as appropriate quality measures. CONCLUSIONS: We identified 8 formally validated quality measures for the performance and interpretation of data from esophageal manometry on the basis of RAM. These measures represent key aspects of a high-quality esophageal manometry study and should be adopted uniformly. These measures should be evaluated in clinical practice to determine how they affect patient outcomes.
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