Document Detail


The effect of nonmedical factors on variations in the performance of colonoscopy among different health care settings.
MedLine Citation:
PMID:  20068487     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Karine Lamiraud; Alberto Holly; Bernard Burnand; Pascal Juillerat; Vincent Wietlisbach; Florian Froehlich; Jean-Jacques Gonvers; John-Paul Vader
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical care     Volume:  48     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-26     Completed Date:  2010-02-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  101-9     Citation Subset:  IM    
Affiliation:
ESSEC Business School, Paris, France. karine.lamiraud@unil.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Canada
Colonoscopy* / economics,  utilization
Europe
Fee-for-Service Plans
Gatekeeping
Health Services Accessibility
Hospitals, Teaching
Humans
Likelihood Functions
Models, Econometric
Physician's Practice Patterns*
Predictive Value of Tests
Quality Indicators, Health Care
Quality of Health Care*
Regression Analysis
Reimbursement Mechanisms
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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