title: Performance measures of surgeon-performed colonoscopy in a Veterans Affairs medical center.
abstract: BACKGROUND
  Quality indicators are increasingly emphasized in the performance of colonoscopy. This study aimed to determine the standard of care rendered by surgeon-endoscopists in a Veterans Affairs (VA) medical center by evaluating the indications for colonoscopy and outcome performance measures according to established quality indicators for colonoscopy.
  
  
  METHODS
  A prospective standardized computer endoscopic reporting database (ProVation MD) was retrospectively reviewed. All colonoscopies performed by attending surgeons at the San Diego VA medical center between 1 January 2004 and 31 July 2007 were included in the study. Patients with charts that had incomplete reporting were excluded. The quality indicators used included the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) criteria for colorectal cancer screening, the American Cancer Society (ACS) guidelines for postcancer resection surveillance, and the American Society of Gastrointestinal Endoscopists (ASGE) quality indicators for colonoscopy.
  
  
  RESULTS
  The data for 558 patients (96% men) were analyzed. The average patient age was 63 years (range, 25-93 years). Almost all the colonoscopies (99%) were performed in accordance with established criteria. The most common indications for colonoscopy were screening (n = 143, 26%), non-acute gastrointestinal bleeding (n = 127, 23%), polyp surveillance (n = 100, 18%), postcancer resection surveillance (n = 91, 17%), abdominal pain (n = 19, 4%), and anemia (n = 14, 3%). Postcancer resection surveillance colonoscopies were performed according to recommended criteria in 98% of the cases. The cecal intubation rate was 97%, and the overall adenoma detection rate was 26%. Two patients (<1%) experienced complications requiring intervention.
  
  
  CONCLUSIONS
  The study data indicate that surgeon-performed colonoscopies meet standard quality criteria for indications and performance measures. The authors therefore conclude that surgeon-endoscopists demonstrate proficiency in the standard of care for colonoscopy examinations.
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA 92103, USA.
authors.forename: H S
authors.initials: HS
authors.lastname: Tran Cao
authors.forename: B C
authors.initials: BC
authors.lastname: Cosman
authors.forename: B
authors.initials: B
authors.lastname: Devaraj
authors.forename: S
authors.initials: S
authors.lastname: Ramamoorthy
authors.forename: T
authors.initials: T
authors.lastname: Savides
authors.forename: M L
authors.initials: ML
authors.lastname: Krinsky
authors.forename: S
authors.initials: S
authors.lastname: Horgan
authors.forename: M A
authors.initials: MA
authors.lastname: Talamini
authors.forename: M K
authors.initials: MK
authors.lastname: Savu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003113:Colonoscopy / Q000009:adverse effects / Q000592:standards*; D003937:Diagnosis, Differential; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States