Programmer Analyst to Improve Digestive Health Quality at Northwestern Medicine

Principal Investigator: Rajesh N. Keswani, MD Among the busiest digestive disease centers in the country, Northwestern Medicine (NM) manages some 35,000 GI endoscopy procedures and more than 42,000 outpatient clinic visits a year. NM clinicians strive to deliver high quality, patient-centered cost-effective care with every patient encounter. Improving the quality of care relies on measuring clinical performance (i.e., “quality metrics”), implementing interventions to improve care delivery, and then re-measuring quality following the interventions. Our group utilized this approach to markedly improve the quality of colonoscopy at Northwestern thereby reducing the risk of colon cancer death after colonoscopy in the patients we serve, and subsequently published this innovative work in a leading journal (American Journal of Gastroenterology, 2015). Although the NM digestive health group has considerable quality improvement expertise, each initiative requires an analyst who has the computer and statistical skills to collect patient and procedure data from the electronic health record and interpret that data in a continuous fashion. The lack of a dedicated analyst has been a persistent bottleneck to replicating this approach to quality improvement research. Funding of the programmer analyst position will now allow the group to support multiple novel quality improvement projects and improve the efficiency of current research...

Can we Improve Doctors’ Colonoscopy Skills with a “Report Card”?

Principal Investigator: Anna Duloy, MD Skills matter when it comes to screening colonoscopies for colon cancer, the second-leading cause of cancer death in the United States. Some doctors are more skilled than others at finding and removing precancerous polyps (known as adenomas) that may lead to cancer if left to grow. Unfortunately, though, the quality of performing this vital procedure varies widely between gastroenterology specialists, even at the best medical institutions. Most commonly, the quality of colonoscopy performance is measured by the adenoma detection rate (ADR):  the frequency of finding adenomas during routine screening colonoscopies. Patients whose physicians have high ADRs are less likely to develop colorectal cancer. While ADR fluctuates among individual doctors, the source of this variability remains a mystery. Constructive criticism can often help improve any endeavor. In prior work, gastroenterology and hepatology fellow Anna Duloy demonstrated that providing feedback regarding polyp detection can significantly improve colonoscopy performance by physicians. Thanks to a Digestive Health Foundation grant, Dr. Duloy’s research team plans to further expand upon on this work by providing new individualized colonoscopy skills feedback to Northwestern Medicine GI specialists. The study will focus on the physicians’ ability to remove polyps (polypectomy) and fully inspect the colon during colonoscopy. Investigators will use video grading by experts to develop pre- and post-scope report cards that will help the specialists to measure their individual performance and ongoing improvement. Patients who overcome their fears and/or other barriers to schedule and undergo a screening colonoscopy expect the very best of care. Increasing colonoscopy competency could further help to stop a common, fatal, digestive disease before it progresses or even...

Developing Video-Based Education to Improve Patient Completion of Colorectal Cancer Screening

Screening colonoscopies have been credited with turning the tide against colorectal cancer—the second leading cause of death in the United States—with early prevention and treatment. Yet barriers, from patient fears to cultural influences, keep many Americans from undergoing the potentially lifesaving procedure. Even when screening colonoscopies are scheduled, no shows and cancellations are common. Some 10 percent of Northwestern Medicine’s scheduled patients change their minds at the last minute and never make it to their appointments. Not only do patients miss out on this effective preventive health screening but they also contribute to wasted healthcare resources due to unfilled endoscopy appointments. Patient education remains critical to convincing individuals of the importance of colon cancer screening. In most busy clinical practices, though, healthcare practitioners often can’t devote the necessary time to the topic. Given the constraints of the current patient-primary care provider relationship, novel methods for delivering this vital information are needed to improve screening rates across the nation. Patient portals have fast become a standard feature of many electronic health records (EHRs) systems.  Allowing patients to schedule appointments, access test results and communicate with their doctors, EHRs can present an alternative channel for patient education materials. Northwestern Medicine investigators have already shown that the use of patient portals for educating patients on the importance of pneumonia vaccinations works. Patients who viewed a video on the subject were significantly more likely, than those who didn’t, to agree to being vaccinated. Thanks to a grant from the Digestive Health Foundation, researchers led by Rajesh N. Keswani, MD, Director of Quality for the Digestive Health Center, will apply the novel patient portal...

Developing a Standardized Training System for Interpreting Esophageal Manometry Exam

Principal investigator:  Rena Yadlapati, MD Every physician strives for and every patient expects an accurate diagnosis—no matter what the health issue. Advancements in imaging and other technologies continue to enhance diagnostic capabilities for a range of diseases, including gastrointestinal disorders. But even the most sophisticated diagnostic tools can yield erroneous results in untrained and/or inexperienced hands. In the field of esophageal disorders, high-resolution esophageal manometry (HREM) is the gold standard for diagnosing certain disorders of the esophagus, including difficulty swallowing. The precision of HREM allows gastroenterologists to track esophageal motility or movement patterns to pinpoint functional problems of this essential digestive organ. While HREM provides invaluable information, the skill and knowledge of the GI specialists using this advanced technology varies widely across the country. From disparities in performance to interpretation of HREM data, the potential for inaccurate diagnosis that adversely impact patient care and quality of life is—unacceptably—too high. Already researchers at Northwestern Medicine have designed a web-based training program and conducted a pilot study: They observed learning curves for HREM among 20 gastroenterology trainees nationwide. Supported by a grant from the Digestive Health Foundation, the investigators led by Rena Yadlapati, MD, will now build on the success of their initial work. They plan to apply their methodology to a larger group of physicians (residents and faculty) with minimal experience with HREM to validate the existing data and determine key competency benchmarks. Dr. Yadlapati’s team will work with the Instructional Design & Development group at Northwestern University to create interactive training modules. They will then integrate interactive educational video and electronic handbooks, among other tools, into their training system....