How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

6533b82efe1ef96bd1293c70

RESEARCH PRODUCT

How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

L Buri G Bersani C Hassan M Anti Ma Bianco L Cipolletta E Di Giulio G Di Matteo Luigi Familiari L Ficano P Loriga S Morini V Pietropaolo A Zambelli E Grossi M Intraligi F Tessari M Buscema The Sied Appropriateness Working Group

subject

Adult Pediatrics medicine.medical_specialty appropriatness Group B Upper Gastrointestinal Tract Age Distribution Medicine Humans Appropriateness Endoscopy Digestive System endoscopy Referral and Consultation Retrospective Studies Ultrasonography Settore MED/12 - Gastroenterologia Hepatology business.industry Patient Selection Upper endoscopy upper endoscopy; appropriatness; endoscopy Gastroenterology Retrospective cohort study Stepwise regression Middle Aged Appropriateness Upper endoscopy Settore MED/18 - Chirurgia Generale Appropriateness; Upper endoscopy Italy ROC Curve Upper endoscopy Practice Guidelines as Topic Age distribution business

description

Abstract BACKGROUND: Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres. METHODS: A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre. RESULTS: discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41-97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively. CONCLUSIONS: A simple predictive rule, based on rate of patients referred by GPs, rate of urgent examinations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs.

year	journal	country	edition	language
2010-01-01

10.1016/j.dld.2010.02.012 http://hdl.handle.net/11570/1902532