title: Developing and Testing an Electronic Measure of Screening Colonoscopy Overuse in a Large Integrated Healthcare System.
abstract: BACKGROUND
  Most existing performance measures focus on underuse of care, but there is growing interest in identifying and reducing overuse.
  
  
  OBJECTIVE
  We aimed to develop a valid and reliable electronic performance measure of overuse of screening colonoscopy in the Veterans Affairs Health Care System (VA), and to quantify overuse in VA.
  
  
  METHODS
  This was a cross-sectional study with multiple cross-sections.
  
  
  METHODS
  U.S. Veterans who underwent screening colonoscopy between 2011 and 2013.
  
  
  METHODS
  Overuse of screening colonoscopy, using a validated electronic measure developed by an expert workgroup.
  
  
  RESULTS
  Compared to results obtained from manual record review, the electronic measure was highly specific (97 %) for overuse, but not sensitive (20 %). After exclusion of diagnostic and high-risk screening or surveillance procedures, the validated electronic measure identified 88,754 average-risk screening colonoscopies performed in VA during 2013. Of these, 20,530 (23 %) met the definition for probable (17 %) or possible (6 %) overuse. Substantial variation in colonoscopy overuse was noted between Veterans Integrated Care Networks (VISNs) and between facilities, with a nearly twofold difference between the maximum and minimum rates of overuse at the VISN level and a nearly eightfold difference at the facility level. Overuse at the VISN and facility level was relatively stable over time.
  
  
  CONCLUSIONS
  Overuse of screening colonoscopy can be measured reliably and with high specificity using electronic data, and is common in a large integrated healthcare system. Overuse measures, such as those we have specified through a consensus workgroup process, could be combined with underuse measures to improve the appropriateness of colorectal cancer screening.
authors.affiliation: Veterans Affairs Center for Clinical Management Research (CCMR), 2215 Fuller Road, 111D, Ann Arbor, MI, 48105, USA. sdsaini@umich.edu.|Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. sdsaini@umich.edu.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. sdsaini@umich.edu.
authors.forename: Sameer D
authors.initials: SD
authors.lastname: Saini
authors.affiliation: Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.|Anthem, Inc, Minneapolis, MN, USA.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC, USA.|Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.affiliation: VHA Office of Analytics and Business Intelligence, Washington, DC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Francis
authors.affiliation: VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Kinsinger
authors.affiliation: VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Pittman
authors.affiliation: Veterans Affairs Center for Clinical Management Research (CCMR), 2215 Fuller Road, 111D, Ann Arbor, MI, 48105, USA.|Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Schoenfeld
authors.affiliation: Veterans Affairs Center for Clinical Management Research (CCMR), 2215 Fuller Road, 111D, Ann Arbor, MI, 48105, USA.|Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Moser
authors.affiliation: Veterans Affairs Center for Clinical Management Research (CCMR), 2215 Fuller Road, 111D, Ann Arbor, MI, 48105, USA.|Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.affiliation: Veterans Affairs Center for Clinical Management Research (CCMR), 2215 Fuller Road, 111D, Ann Arbor, MI, 48105, USA.|Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods / Q000639:trends*; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000639:trends*; D055088:Early Detection of Cancer / Q000379:methods / Q000639:trends*; D057286:Electronic Health Records / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs / Q000639:trends*; D058014:Veterans Health / Q000639:trends*
keywords: colorectal cancer; health services research; performance measurement; screening