Quality of Colonoscopies in Multispecialty Community-Based Outpatient Clinics

The VA Office of Inspector General (OIG) conducted a national review to evaluate colonoscopy care delivered in Veterans Health Administration (VHA) multispecialty community-based outpatient clinics (CBOC). This review focused on quality indicators for CBOC colonoscopy providers’ practice evaluations, the extent to which CBOC colonoscopy procedure quality assurance monitoring occurred, CBOC emergency care preparations, and facility and national quality assurance monitoring. The OIG determined that VHA’s required colonoscopy quality indicators were not monitored in a standardized way that allowed for verification of the quality of colonoscopies performed by CBOC providers. Further, the OIG determined that colonoscopy quality indicator data was not analyzed for CBOC providers in a way that facilitated comprehensive quality assurance. CBOC, facility, and VHA leaders could not consistently identify gaps in colonoscopy quality at the CBOCs due to lack of standardized monitoring processes. CBOC staff managed potential risks associated with colonoscopy procedures and complied with VHA requirements for monitoring patients during colonoscopies, having emergency medical equipment available, and having an after-hours medical emergency policy. VHA’s colorectal cancer screening directive lacked requirements for monitoring compliance with VHA’s colonoscopy quality indicators, and the OIG identified potential recurring gaps in colonoscopy quality monitoring. The OIG identified limitations in VHA’s National Gastroenterology Program Office’s ability to monitor colonoscopies for quality assurance because of variations in quality indicator data collection and lack of consistency in implementation of endoscopy software as a data collection tool. The OIG made three recommendations to the Under Secretary for Health related to requirements for colonoscopy quality indicators in professional practice evaluation, colonoscopy quality assurance monitoring, and evaluating and recommending endoscopy software for standardized implementation for quality assurance monitoring.