International Journal for Quality in Health Care Advance Access originally published online on March 8, 2007
International Journal for Quality in Health Care 2007 19(3):150-157; doi:10.1093/intqhc/mzm008
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The appropriateness of colonoscopy: a multi-center, international, observational study
1 Institute of Social and Preventive Medicine, University of Lausanne, CH-1005 Lausanne, Switzerland
2 Division of Gastroenterology and Hepatology, Policlinique Médicale Universitaire, Lausanne, Switzerland
3 Gastroenterology Department, University of Basle, Basle, Switzerland
Objective. To examine the appropriateness and necessity of colonoscopy across Europe.
Design. Prospective observational study.
Setting. A total of 21 gastrointestinal centers from 11 countries.
Participants. Consecutive patients referred for colonoscopy at each center.
Intervention. Appropriateness criteria developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy, using the RAND appropriateness method, were used to assess the appropriateness of colonoscopy.
Main outcome measure. Appropriateness of colonoscopy.
Results. A total of 5213 of 6004 (86.8%) patients who underwent diagnostic colonoscopy and had an appropriateness rating were included in this study. According to the criteria, 20, 26, 27, or 27% of colonoscopies were judged to be necessary, appropriate, uncertain, or inappropriate, respectively. Older patients and those with a major illness were more likely to have an appropriate or necessary indication for colonoscopy as compared to healthy patients or patients who were 45–54 years old. As compared to screening patients, patients who underwent colonoscopy for iron-deficiency anemia [OR: 30.84, 95% CI: 19.79–48.06] or change in bowel habits [OR: 3.69, 95% CI: 2.74–4.96] were more likely to have an appropriate or necessary indication, whereas patients who underwent colonoscopy for abdominal pain [OR: 0.64, 95% CI: 0.49–0.83] or chronic diarrhea [OR: 0.54, 95% CI: 0.40–0.75] were less likely to have an appropriate or necessary indication.
Conclusions. This study identified significant proportions of inappropriate colonoscopies. Prospective use of the criteria by physicians referring for or performing colonoscopies may improve appropriateness and quality of care, especially in younger patients and in patients with nonspecific symptoms.
Keywords: appropriateness of care, colonoscopy, expert panel, health services research, practice guidelines, RAND appropriateness method
Address reprint requests to: John-Paul Vader, Institute of Social and Preventive Medicine, Rue du Bugnon 17, CH-1005, Lausanne, Switzerland. Tel.: +41 21 314 72 80; Fax: +41 21 314 49 54; E-mail: john-paul.vader{at}chuv.ch
Deceased 2004. Accepted for publication February 5, 2007.
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