Identification of Quality Measures for Performance of and Interpretation of Data From Esophageal Manometry.
OBJECTIVE
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.
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: rena.yadlapati@northwestern.edu.
Rena
R
Yadlapati
Division of Gastroenterology, University of Utah, Salt Lake City, Utah.
Andrew J
AJ
Gawron
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Rajesh N
RN
Keswani
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.
Karl
K
Bilimoria
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.
Donald O
DO
Castell
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center and the Dallas VA Medical Center, Dallas, Texas.
Kerry B
KB
Dunbar
Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri.
Chandra P
CP
Gyawali
Esophageal and Thoracic Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
Blair A
BA
Jobe
Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
Philip O
PO
Katz
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
David A
DA
Katzka
Division of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Brian E
BE
Lacy
Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Benson T
BT
Massey
Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida.
Joel E
JE
Richter
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York.
Felice
F
Schnoll-Sussman
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center and the Dallas VA Medical Center, Dallas, Texas.
Stuart J
SJ
Spechler
Department of Surgery, University of Washington, Seattle, Washington.
Roger
R
Tatum
Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona.
Marcelo F
MF
Vela
Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
John E
JE
Pandolfino
D000328:Adult; D000368:Aged; D015154:Esophageal Motility Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D011787:Quality of Health Care
Esophageal Manometry; High-Resolution Manometry; Quality Measures; RAND/UCLA Appropriateness Methodology