AGA Institute Quality Indicator Development for Irritable Bowel Syndrome

Published in the journal Gastroenterology. Here is a link to the article.

Regenstrief Institute authors: Jennifer Maratt, PhD

Irritable bowel syndrome (IBS) is a common condition characterized by recurrent abdominal pain associated with a change in stool form or frequency, which may be diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or marked by mixed bowel habits (IBS-M). Studies have shown substantial variation in the care of patients with IBS, often including extensive diagnostic testing leading to unnecessary health care expenditures without notable improvements in outcomes. In addition to the impact on quality of life, this leads to a considerable economic burden related to absenteeism and direct medical expenses. A positive diagnostic approach using Rome Criteria has been recommended by multiple guidelines for patients with IBS symptoms as a cost-effective strategy to reduce treatment delay and minimize costly low-value testing. However, IBS is still viewed by many as a diagnosis of exclusion after performing multiple tests. These realities highlight the need to develop standards for improving the quality of care in IBS.

Quality measures are well-defined, structured tools that can be used for benchmarking and quantification of health care outcomes; they undergo rigorous development before their inclusion in quality payment programs, such as the Merit-Based Incentive Payment System. In some instances, quality measures may be narrow in scope or difficult to collect, which encouraged the development of a novel pathway for quality indicator development by the American Gastroenterological Association (AGA). Quality indicators are less structured concepts of quality related to disease states and processes. Quality indicators are not guidelines, nor are they meant to replace guidelines, and, unlike quality measures, they are not intended for national accountability programs. They also do not constitute all aspects of quality care within a condition and are not intended for use in insurance coverage decisions. Quality indicators highlight aspects of evidence-based, high-quality care with the aim to stimulate participation in quality improvement activities broadly and reduce variation in care.

The AGA Quality Committee reviewed the recently published AGA IBS guidelines. Although none of the practice recommendation statements were selected for quality measure development, these statements, along with others from sources, including AGA IBS Clinical Practice Updates, international guidelines, and consensus statements related to diagnosis, management, diet, and the brain–gut axis, were subsequently evaluated for IBS quality indicator development. This document presents the official recommendations and outlines the AGA Quality Committee’s approach to quality indicator development related to the diagnosis, evaluation, and management of IBS and, when applicable, a discussion of the rationale for forgoing quality measure development.

Authors

Kenneth W. Hung,¹ David A. Leiman,^2,3 Archana Kaza,⁴ Rabindra Watson,⁵ Lin Chang,⁶ and Jennifer K. Maratt,^7,8 on behalf of the American Gastroenterological Association Quality Committee

Author Affiliations

¹Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut;

²Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina;

³Duke Clinical Research Institute, Durham, North Carolina;

⁴Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, New Mexico;

⁵Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California;

⁶Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California;

⁷Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana; and

⁸Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana