Who Is at Risk for Early-Onset Colorectal Cancer?

Modern medical decision making, whether preventive, diagnostic, or therapeutic, emphasizes the risk stratification of patients, and is heavily informed and influenced by evidence-based guidelines. Such guidelines for colorectal cancer (CRC) screening were first published in 1997,1 and subsequently by multiple professional organizations. Although there have been disagreements regarding choice of screening modality, the start age of 50 years for most average-risk individuals (with the notable exception of African Americans) has been mostly unchallenged

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

This document presents the official recommendations of the American Gastroenterological Association (AGA) regarding quality measures related to the diagnosis and management of the novel coronavirus, SARS-CoV-2. The current report outlines the process by which the Quality Committee (QC) evaluates guidance statements published by the AGA’s Clinical Guidelines Committee (CGC) to inform measure development. The recommendations discussed in this report relate to what remains an unprecedented event in contemporary history with unique challenges for CGC guidance-related measure development. The following recommendations were developed by the QC in consultation with the CGC. Their development was fully funded by the AGA Institute, with no additional outside funding.The AGA Institute provided funding for creation of this document

Outcome Measures for Interventions to Reduce Inappropriate Chronic Drugs: A Narrative Review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/3/jgs16697-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/2/jgs16697_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/1/jgs16697.pd

Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

Background: In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods: We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results: Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion: Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

This document presents the official recommendations of the American Gastroenterological Association (AGA) regarding quality measures related to the diagnosis and management of the novel coronavirus, SARS-CoV-2. The current report outlines the process by which the Quality Committee (QC) evaluates guidance statements published by the AGA’s Clinical Guidelines Committee (CGC) to inform measure development. The recommendations discussed in this report relate to what remains an unprecedented event in contemporary history with unique challenges for CGC guidance-related measure development. The following recommendations were developed by the QC in consultation with the CGC. Their development was fully funded by the AGA Institute, with no additional outside funding.The AGA Institute provided funding for creation of this document

Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

Background: In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods: We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results: Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion: Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources

Outcome Measures for Interventions to Reduce Inappropriate Chronic Drugs: A Narrative Review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/3/jgs16697-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/2/jgs16697_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163374/1/jgs16697.pd

AGA Institute Quality Indicator Development and Uses

The Affordable Care Act, which was signed into law in 2010, established several national priorities for health care delivery, including reinforcing the importance of high-value health care. Cost and quality are fundamental functions of value. Although costs may be clearly definable, quality can be more elusive to calculate and measure. The use of structured quality measures, which are standardized tools to quantify health care processes and outcomes, can reduce variability in quality reporting. One prominent example of a gastroenterology-focused quality measure is the adenoma detection rate, which reflects the percentage of average-risk screening colonoscopies in which at least 1 adenoma is detected. Like adenoma detection rate, all quality measures require discrete specifications for calculating a numerator and denominator to allow widespread standardization and reliable measurement across practices. Ultimately, this reproducibility permits the establishment of benchmark targets, which in turn allow insights into variable measure adherence and opportunity to develop and implement improvement

AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia with Helicobacter pylori

Gastric cancer is the third leading cause of cancer-related deaths worldwide, with more than 1 million incident cases diagnosed globally. 1 Non-cardia intestinal-type gastric cancer, the most common subtype of gastric cancer, develops through the Correa cascade in which chronic inflammation of normal gastric mucosa leads to atrophic gastritis, followed by gastric intestinal metaplasia (GIM), dysplasia, and ultimately gastric cancer. 2 GIM has an estimated prevalence of 4.8% in the United States based on an analysis of gastric biopsies from a large pathology database, but higher rates of GIM have been reported in certain racial and ethnic groups (14.8% in Asian Americans, 18.2% in Native Americans, 25.5% in African Americans, and 29.5% in Hispanic Americans). 3 ,4 Additional risk factors for GIM include tobacco use, autoimmune gastritis, and living or immigrating from an endemic area. The annual risk of progression from GIM to non-cardia intestinal-type gastric cancer is 0.16%, and factors such as persistent Helicobacter pylori infection, family history, anatomic extent and location of GIM, and histologic subtypes may confer increased risk of progression to gastric cancer. 5 Studies of U.S. endoscopists show variation in the management of patients with GIM, including use and interval for endoscopic surveillance, prompting the development of guidelines for the management of GIM