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Better outcomes reported from high-volume providers of complex endoscopic procedure
Date:11/18/2013

t, M.D., M.S., the paper's first author and an assistant professor of medicine at the Indiana University School of Medicine Division of Gastroenterology and Hepatology. Those risks include tearing of the intestinal wall, pancreatitis, internal hemorrhage, complications from anesthesia, and infections. "Having two interventions in such a short time span induces substantial anxiety for patients and their loved ones, and the implications on health care costs are clear. In a fee-for-service reimbursement structure, there is little incentive to minimize or eliminate these repeat procedures."

Using data collected by the Regenstrief Institute, Dr. Cot and colleagues found that 116 of the 130 doctors surveyed did two or fewer ERCPs a week, or fewer than 117 ERCPs per year. In that low-volume group, nearly 10 percent of patients needed a second procedure within seven days.

In the high-volume group -- physicians who performed more than 117 ERCPs per year -- and even after accounting for the fact that ERCPs performed by these providers were typically for more complex indications, there was a 6 percent incidence of repeat procedures within seven days of the initial procedure. The data showed that as the number of procedures performed by a physician increased, the failure rate decreased. Physicians who perform more than 117 ERCPs per year had similar failure rates, suggesting this as an approximate threshold for a provider to maintain technical proficiency.

"The rate of immediate hospitalizations nearly doubled (28 percent) when ERCP was performed by a physician in the low-volume group as compared to a rate of 15 percent when performed by a physician in the high-volume group," Dr. Cot said.

He said there has been little effort to concentrate ERCP services at fewer hospitals, unlike some high-risk surgical procedures such as pancreatic surgery. At a time when health care costs are under the microscope, this research, funded by the National Ins
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Contact: Mary Hardin
mhardin@iu.edu
317-274-5456
Indiana University
Source:Eurekalert  

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