Quality indicators for ERCP

ERCP is one of the most technically demanding and highstudies. Clinical studies were identified through a computerrisk procedures performed by GI endoscopists. It requires significant focused training and experience to maximize success and to minimize poor outcomes. ERCP has evolved from a purely diagnostic to a predominately therapeutic procedure. ERCP and ancillary interventions are effective in the non-surgical management of a variety of pancreaticobiliary disorders, most commonly the removal of bile duct stones and relief of malignant obstructive jaundice. The American Society for Gastrointestinal Endoscopy (ASGE) has published specific criteria for training and granting of clinical privileges for ERCP, which detail the many skills that must be developed to perform this procedure in clinical practice with high quality. 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. A quality indicator often is 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, rates of 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, rate of cannulation of the desired duct), and (3) outcome measures dthese assess the results of the care that was provided (eg, rates of adverse events such as pancreatitis after ERCP).