- Email: [email protected]
Sa1116 National Quality Improvement Project for Inflammatory Bowel Disease Services in the UK (IBD-Qip)
AGA Abstracts
of H. pylori is very important to prevent the pathogenesis of gastric carcinoma. A novel onestep multiplex PCR detection system was developed. This system can amplify 10 DNA fragments from 5 DNA regions in the genome of H. pylori at the same time. The objective of this study was to assess the diagnostic value of this new multiplex PCR assay to detect H. pylori infection for those Asian patients with gastritis, negative CLO test and negative Immunoperoxidase stain. Methods:From 1/1/2010 to 6/30/2011 (18 months), extra gastric samples (one from antrum and one from body) were obtained in all Asian patients with endoscopic evidence of gastritis, and placed in a test tube with Lysis solution . When the CLO tests and the Immunoperoxidase stain were negative for H. pylori, the samples were sent to TZAM Diagnostics Laboratory for the HP M-PCR test. Results: From 1/1/2010 to 6/ 30/2011 (18 months), 901 esophagogastroduodenoscopies were performed and 93 were Asian patients. 17/88 had gastritis with intestinal metaplasia: age46-88; 7 males and 10 females. 7/17 were on PPI(6) or Pepcid(1), 4 had negative CLO tests and Immunoperoxidase stains, ¾ had positive HP M-PCR (75%); 10/17 were not on PPI or H2 blockers, 5 had negative CLO tests and Immunoperoxidase stains, 2/5 had positive HP M-PCR (40%). Of the 17 patients with gastritis and intestinal metaplasia, 5 patients (29.4%) changed the treatment strategies because of the positive HP M-PCR, especially in those patients taking PPI/Pepcid (75% versus 40%). Conclusions:Our study showed that HP M-PCR can increase the diagnostic yields of positive H. pylori in those Asian patients with gastritis, intestinal metaplasia (29.4%), especially for those on PPI/Pepcid (75% versus 40%). These can potentially prevent these patient from degenerating to gastric cancer formation (adenocarcinoma). Since the number of patients is small, a call for a larger study is suggested.
testing identified 16 patients (4.5%) with a clinical diagnosis of HNPCC and 90 living firstdegree relatives (FDR) benefited from these results. Post-intervention, among 74 eligible patients treated between May and July, 2011, 72 (97.3%) had IHC and 53 (71.6%) had PCR testing, representing significant increases in test utilization (Figure). When stratified by specialty, testing rates for patients seen in medical oncology improved from 57 to 98% for IHC and 28.3 to 65.3% for PCR testing from baseline; the corresponding rates for surgical oncology were 66.7 to 100% for IHC and 52.7 to 90.5% for PCR testing. Ensuing genetic workup identified 8 (10.8%) otherwise unsuspected patients to have clinical HNPCC and 43 FDRs also benefited from these test results. Conclusions: Significant missed opportunities for optimal care for young patients and their at-risk family members existed at baseline. Through a multidisciplinary intervention program, the utilization of tumor-based studies as a first-step screening for diagnosis of HNPCC significantly increased. Best patient-centered care practice for young-onset CRC should include universal tumor MSI status testing.
Sa1116 National Quality Improvement Project for Inflammatory Bowel Disease Services in the UK (IBD-Qip) Ian Shaw, Emma Fernandez Introduction Inflammatory Bowel Disease (IBD) is a common cause of gastrointestinal morbidity with an estimated 240,000 people affected in the UK, at an annual cost to the NHS of £720 million. Successive rounds of UK wide audit have shown wide variation in IBD care provision and a need to implement the nationally agreed Standards for IBD Care that were published in 2009 (http://www.ibdstandards.org.uk). Here we report the results from the first round of the IBD-QIP, a national pilot project to support services in achieving the national quality standards by developing a web-based system (www.ibdqip.co.uk), comprising a combination of self-assessment tool and a shared repository of best practice. Intervention The assessment tool, which was modelled on the successful ‘GRS system' used in UK endoscopy quality assurance, comprised a series of statements grouped into a hierarchical grading system (rated A-D), covering 4 domains: patient experience, clinical quality, organisation and patient choice, research education and audit. The statements were developed by a group of experts to reflect the IBD Standards and National Audit results. Sites were asked to record their self assessment after meeting as a multidisciplinary team with patient representation. Sites provided feedback on the statements to allow refinement of the tool and were encouraged to share best practice using an on line document store and through regional meetings. Results 73 sites enrolled in the pilot (64 adult & 9 paediatric services - collectively serving an estimated 18 million of the UK population). 62/73 sites (85%) provided data. 52/62 sites (90%) carried out the self assessment as a multidisciplinary team of > 2 professional disciplines (physician, surgeon, nurse etc), but only 6/62 (10%) sites involved a patient. 93% of sites completed the process in < 4 hours. Self assessment scores across all domains were broadly similar between adult and paediatric sites with 18, 17, 23 and 43% of adult services and 14, 12, 26 and 48% of paediatric services obtaining A, B, C and D scores respectively. The on-line document store proved popular and currently contains >150 documents. Conclusion The pilot study has demonstrated that it is feasible to use a web based tool to enable services to benchmark their progress against nationally agreed standards for IBD care. Round 1 results show that the majority of services are failing to meet the UK IBD Standards, with over half of the results rated at level C or D. A further round of assessment, using amended statements based on feedback received from sites, is planned for early 2012 and should clarify whether the project has identified its main aim of assisting sites to improve their service.
Sa1118 Does the Day of the Week Influence Adenoma Detection Rate? Victor Ciofoaia, Mark J. Metwally, Harshit S. Khara, Vlad Denis Constantin, Stephen O'Mahony, Robert Greiner, Dennis M. Meighan, William B. Hale, Seth A. Gross Purpose: The U.S. Multisociety Colorectal Cancer Task Force supports the adenoma detection rate (ADR) as a quality indicator to benchmark endoscopists. As part of a quality improvement project we reviewed the impact of the day of the week on adenoma detection rate. Methods: A retrospective analysis using data mining techniques identified colonoscopies performed at our hospital from 2/2001 to 10/2011. We computed ADR for each day of the week when the screening colonoscopy was performed. Patient demographics including age, race and gender were analyzed. Adenoma detection rate was defined as the number of adenomas divided to the number of screening colonoscopies performed. Pearson Chi-Square was used to test all associations evaluated. Results: A total of 65684 colonoscopies and 39236 associated pathology reports were reviewed; 41669 were screening colonoscopies for colorectal cancer. Our study population was 51.91% female, with a mean age of 59.3 years, and 84.19 % Caucasian. Average ADR for the entire week was 21.84; ADR on Monday was 24.92 (statistically significant higher compared to the rest of the days of the week, p < 0.0018). ADR for Wednesday was 18.54, statistically significant lower compared to the rest of the days of the week, p < 0.0001). These relationships held when the studied population was separated by gender and race. No other statistical significant relationships could be detected. Conclusion: In our population, a retrospective analysis of ADR for screening colonoscopies revealed that ADR is higher at the beginning of the week, which was statistically significant. Further prospective studies are needed to isolate confounders and the identify other factors that could determine the effect of day of the week on adenoma detection rate. ADR per gender for each day of the week
Sa1117 Toward Universal Testing for Hereditary Nonpolyposis Colorectal Cancer (HNPCC) Syndrome in Young Patients With Colorectal Cancer: A Quality Improvement Initiative Y. Nancy You, Sarah A. Bannon, Melissa Taggart, Colleen Reeves, Cathy Modaro, John M. Skibber, Miguel Rodriguez-Bigas, Patrick M. Lynch Introduction: Optimal patient-centered care for young(≤age 50) patients with colorectal cancer (CRC) should include not only cancer-directed treatments but also a diagnostic workup for inheritable predisposition for CRC. Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common inherited CRC syndrome, and its diagnosis significantly alters the management of the patient and the family. This quality improvement project aimed to universally test CRCs for microsatellite (MSI) status as a first-step screening test toward identifying HNPCC among patients with young-onset CRC. Methods: Young(≤age 50) CRC patients receiving multidisciplinary care at a tertiary-referral cancer center were identified. The proportion of eligible patients who had tumor MSI testing was retrospectively reviewed for baseline data (July 2009-June 2010). Patients were seen through medical oncology(69%), surgical oncology(26%), or other departments(5%). Process flow and cause-effect analyses identified failure to order testing, particularly by medical oncologists, as a key target area. In 2011, a 3-part intervention was implemented, including: education of all staff and multidisciplinary providers, visual cue and aids for ordering, and prospective real-time audit. Post-intervention data was prospectively analyzed using P-control charts. The number of patients and first-degree relatives who benefited from tumor testing was calculated. Results: Among 356 eligible patients at baseline, tumor MSI testing by immunohistochemistry (IHC) of DNA mismatch repair protein expression occurred in 209 patients (58.7%), while PCRbased MSI testing occurred in only 122 (34.3%). These tumor tests and follow-up genetic
AGA Abstracts
S-220
of H. pylori is very important to prevent the pathogenesis of gastric carcinoma. A novel onestep multiplex PCR detection system was developed. This system can amplify 10 DNA fragments from 5 DNA regions in the genome of H. pylori at the same time. The objective of this study was to assess the diagnostic value of this new multiplex PCR assay to detect H. pylori infection for those Asian patients with gastritis, negative CLO test and negative Immunoperoxidase stain. Methods:From 1/1/2010 to 6/30/2011 (18 months), extra gastric samples (one from antrum and one from body) were obtained in all Asian patients with endoscopic evidence of gastritis, and placed in a test tube with Lysis solution . When the CLO tests and the Immunoperoxidase stain were negative for H. pylori, the samples were sent to TZAM Diagnostics Laboratory for the HP M-PCR test. Results: From 1/1/2010 to 6/ 30/2011 (18 months), 901 esophagogastroduodenoscopies were performed and 93 were Asian patients. 17/88 had gastritis with intestinal metaplasia: age46-88; 7 males and 10 females. 7/17 were on PPI(6) or Pepcid(1), 4 had negative CLO tests and Immunoperoxidase stains, ¾ had positive HP M-PCR (75%); 10/17 were not on PPI or H2 blockers, 5 had negative CLO tests and Immunoperoxidase stains, 2/5 had positive HP M-PCR (40%). Of the 17 patients with gastritis and intestinal metaplasia, 5 patients (29.4%) changed the treatment strategies because of the positive HP M-PCR, especially in those patients taking PPI/Pepcid (75% versus 40%). Conclusions:Our study showed that HP M-PCR can increase the diagnostic yields of positive H. pylori in those Asian patients with gastritis, intestinal metaplasia (29.4%), especially for those on PPI/Pepcid (75% versus 40%). These can potentially prevent these patient from degenerating to gastric cancer formation (adenocarcinoma). Since the number of patients is small, a call for a larger study is suggested.
testing identified 16 patients (4.5%) with a clinical diagnosis of HNPCC and 90 living firstdegree relatives (FDR) benefited from these results. Post-intervention, among 74 eligible patients treated between May and July, 2011, 72 (97.3%) had IHC and 53 (71.6%) had PCR testing, representing significant increases in test utilization (Figure). When stratified by specialty, testing rates for patients seen in medical oncology improved from 57 to 98% for IHC and 28.3 to 65.3% for PCR testing from baseline; the corresponding rates for surgical oncology were 66.7 to 100% for IHC and 52.7 to 90.5% for PCR testing. Ensuing genetic workup identified 8 (10.8%) otherwise unsuspected patients to have clinical HNPCC and 43 FDRs also benefited from these test results. Conclusions: Significant missed opportunities for optimal care for young patients and their at-risk family members existed at baseline. Through a multidisciplinary intervention program, the utilization of tumor-based studies as a first-step screening for diagnosis of HNPCC significantly increased. Best patient-centered care practice for young-onset CRC should include universal tumor MSI status testing.
Sa1116 National Quality Improvement Project for Inflammatory Bowel Disease Services in the UK (IBD-Qip) Ian Shaw, Emma Fernandez Introduction Inflammatory Bowel Disease (IBD) is a common cause of gastrointestinal morbidity with an estimated 240,000 people affected in the UK, at an annual cost to the NHS of £720 million. Successive rounds of UK wide audit have shown wide variation in IBD care provision and a need to implement the nationally agreed Standards for IBD Care that were published in 2009 (http://www.ibdstandards.org.uk). Here we report the results from the first round of the IBD-QIP, a national pilot project to support services in achieving the national quality standards by developing a web-based system (www.ibdqip.co.uk), comprising a combination of self-assessment tool and a shared repository of best practice. Intervention The assessment tool, which was modelled on the successful ‘GRS system' used in UK endoscopy quality assurance, comprised a series of statements grouped into a hierarchical grading system (rated A-D), covering 4 domains: patient experience, clinical quality, organisation and patient choice, research education and audit. The statements were developed by a group of experts to reflect the IBD Standards and National Audit results. Sites were asked to record their self assessment after meeting as a multidisciplinary team with patient representation. Sites provided feedback on the statements to allow refinement of the tool and were encouraged to share best practice using an on line document store and through regional meetings. Results 73 sites enrolled in the pilot (64 adult & 9 paediatric services - collectively serving an estimated 18 million of the UK population). 62/73 sites (85%) provided data. 52/62 sites (90%) carried out the self assessment as a multidisciplinary team of > 2 professional disciplines (physician, surgeon, nurse etc), but only 6/62 (10%) sites involved a patient. 93% of sites completed the process in < 4 hours. Self assessment scores across all domains were broadly similar between adult and paediatric sites with 18, 17, 23 and 43% of adult services and 14, 12, 26 and 48% of paediatric services obtaining A, B, C and D scores respectively. The on-line document store proved popular and currently contains >150 documents. Conclusion The pilot study has demonstrated that it is feasible to use a web based tool to enable services to benchmark their progress against nationally agreed standards for IBD care. Round 1 results show that the majority of services are failing to meet the UK IBD Standards, with over half of the results rated at level C or D. A further round of assessment, using amended statements based on feedback received from sites, is planned for early 2012 and should clarify whether the project has identified its main aim of assisting sites to improve their service.
Sa1118 Does the Day of the Week Influence Adenoma Detection Rate? Victor Ciofoaia, Mark J. Metwally, Harshit S. Khara, Vlad Denis Constantin, Stephen O'Mahony, Robert Greiner, Dennis M. Meighan, William B. Hale, Seth A. Gross Purpose: The U.S. Multisociety Colorectal Cancer Task Force supports the adenoma detection rate (ADR) as a quality indicator to benchmark endoscopists. As part of a quality improvement project we reviewed the impact of the day of the week on adenoma detection rate. Methods: A retrospective analysis using data mining techniques identified colonoscopies performed at our hospital from 2/2001 to 10/2011. We computed ADR for each day of the week when the screening colonoscopy was performed. Patient demographics including age, race and gender were analyzed. Adenoma detection rate was defined as the number of adenomas divided to the number of screening colonoscopies performed. Pearson Chi-Square was used to test all associations evaluated. Results: A total of 65684 colonoscopies and 39236 associated pathology reports were reviewed; 41669 were screening colonoscopies for colorectal cancer. Our study population was 51.91% female, with a mean age of 59.3 years, and 84.19 % Caucasian. Average ADR for the entire week was 21.84; ADR on Monday was 24.92 (statistically significant higher compared to the rest of the days of the week, p < 0.0018). ADR for Wednesday was 18.54, statistically significant lower compared to the rest of the days of the week, p < 0.0001). These relationships held when the studied population was separated by gender and race. No other statistical significant relationships could be detected. Conclusion: In our population, a retrospective analysis of ADR for screening colonoscopies revealed that ADR is higher at the beginning of the week, which was statistically significant. Further prospective studies are needed to isolate confounders and the identify other factors that could determine the effect of day of the week on adenoma detection rate. ADR per gender for each day of the week
Sa1117 Toward Universal Testing for Hereditary Nonpolyposis Colorectal Cancer (HNPCC) Syndrome in Young Patients With Colorectal Cancer: A Quality Improvement Initiative Y. Nancy You, Sarah A. Bannon, Melissa Taggart, Colleen Reeves, Cathy Modaro, John M. Skibber, Miguel Rodriguez-Bigas, Patrick M. Lynch Introduction: Optimal patient-centered care for young(≤age 50) patients with colorectal cancer (CRC) should include not only cancer-directed treatments but also a diagnostic workup for inheritable predisposition for CRC. Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common inherited CRC syndrome, and its diagnosis significantly alters the management of the patient and the family. This quality improvement project aimed to universally test CRCs for microsatellite (MSI) status as a first-step screening test toward identifying HNPCC among patients with young-onset CRC. Methods: Young(≤age 50) CRC patients receiving multidisciplinary care at a tertiary-referral cancer center were identified. The proportion of eligible patients who had tumor MSI testing was retrospectively reviewed for baseline data (July 2009-June 2010). Patients were seen through medical oncology(69%), surgical oncology(26%), or other departments(5%). Process flow and cause-effect analyses identified failure to order testing, particularly by medical oncologists, as a key target area. In 2011, a 3-part intervention was implemented, including: education of all staff and multidisciplinary providers, visual cue and aids for ordering, and prospective real-time audit. Post-intervention data was prospectively analyzed using P-control charts. The number of patients and first-degree relatives who benefited from tumor testing was calculated. Results: Among 356 eligible patients at baseline, tumor MSI testing by immunohistochemistry (IHC) of DNA mismatch repair protein expression occurred in 209 patients (58.7%), while PCRbased MSI testing occurred in only 122 (34.3%). These tumor tests and follow-up genetic
AGA Abstracts
S-220