Quality indicators for EGD

EGD is used widely for the diagnosis and treatment of esophageal, gastric, and small-bowel disorders. When properly performed, it is generally safe and well-tolerated for the examination of the upper GI tract. Included among the many accepted indications for EGD are evaluation of dysphagia, GI bleeding, peptic ulcer disease, medically refractory GERD, esophageal strictures, celiac disease, and unexplained diarrhea. During EGD evaluation, diagnostic biopsies can be performed as well as therapies to achieve hemostasis and dilation or stenting for significant strictures. In 2009, an estimated 6.9 million EGD procedures were performed in the United States at an estimated cost of $12.3 billion dollars. From 2000 to 2010, a 50% increase in EGD utilization was observed among Medicare recipients. The quality of health care can be measured by comparing the performance of an individual or a group of individuals with an ideal or benchmark. The particular parameter that is being used for comparison is termed a quality indicator. Quality indicators may be reported as a ratio between the incidence of correct performance and the opportunity for correct performance or as the proportion of interventions that achieve a predefined goal. Quality indicators can be divided into 3 categories: (1) structural measuresdthese assess characteristics of the entire health care environment (eg, participation by a physician or other clinician in a systematic clinical database registry that includes consensus endorsed quality measures), (2) process measuresdthese assess performance during the delivery of care (eg, frequency with which appropriate prophylactic antibiotics are given before placement of a PEG tube), and (3) outcome measuresdthese assess the results of the care that was provided (eg, rates of adverse events after EGD).