Evidence map›Paper›PMID 38135304›Full record

ArticleBMJ open quality2023

Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system.

Courtney A Reynolds, Vishnu Nair, Chad Villaflores, Katherine Dominguez, Julia Cave Arbanas, Madeline Treasure, Samuel Skootsky, Chi-Hong Tseng, Catherine Sarkisian, Arpan Patel and 4 more

Open access · goldAbstract read
PubMed Publisher
In one paragraph

Article in BMJ open quality, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.3field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 1 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 1 country.

Courtney A ReynoldsDepartment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.ORCID 0000-0002-0298-1039
Vishnu NairDepartment of Medicine, Stanford University, Stanford, California, USA.
Chad VillafloresDepartment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Katherine DominguezDepartment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Julia Cave ArbanasDepartment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Madeline TreasureDepartment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Samuel SkootskyDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Chi-Hong TsengDepartment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Catherine SarkisianDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.ORCID 0000-0003-2768-2323
Arpan PatelThe Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Kevin GhassemiThe Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
A Mark FendrickDepartment of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Folasade P MayUCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, Los Angeles, Calif, USA.
John N MafiDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA jmafi@mednet.ucla.edu.
University of California, Los Angeles · USKaiser Permanente · USRAND Corporation · USStanford University · USUniversity of Michigan · US

Funding

Midcareer Award in Patient-Oriented Community-Academic Partnered Aging ResearchK24AG047899 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SARKISIAN, CATHERINE A · 2014 to 2025
$2.0M
Leveraging Electronic Health Records to Measure and Reduce Harmful, Low-Value Care Among Older AdultsK76AG064392 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI MAFI, JOHN · 2020 to 2024
$1.2M
NIA NIH HHS K24 AG047899NIA NIH HHS K76 AG064392
6 · The paper itself

Abstract

objectivesLow-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) 'eMeasure' to detect low-value EGDs.

designRetrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019.

settingOutpatient primary care and gastroenterology clinics at a large, urban, academic health centre.

participantsAdult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019.

main outcome measuresEGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett's oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure's validity. We estimated EGD costs using Medicare physician and facility fee rates.

resultsAmong 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure's sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients' out-of-pocket costs.

conclusionsWe developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at the point of care.

Indexed as

Electronic Health RecordsGastroesophageal RefluxAdultAgedEndoscopy, Digestive SystemFemaleHumansMaleMedicareMiddle AgedRetrospective StudiesUnited Stateshealthcare quality improvementpatient safetyquality improvement

Identifiers

PMID38135304
OpenAlexW4390116599

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.