Table 2.
High-validity GERD Care Quality Measures.
| Median Rankings (Individual panelist rankings) | |
|---|---|
| Initial Diagnosis & Management (n=7) | |
| IF a patient has typical GERD, THEN an initial trial of empiric PPI therapy, H2RA, or antacid is appropriate.† | Round 1: 8.0 (8, 7, 9, 9, 9, 7, 8, 8) |
| IF PPI therapy is initiated, THEN it should be at once a day dosing before the first meal of the day (or before an evening meal for patients with predominant nighttime symptoms).† | Round 1: 9.0 (9, 9, 9, 9, 9, 8, 8, 9) Round 2: 9.0 (9, 9, 9, 9, 9, 8, 8, 9) |
| IF a patient with a diagnosis of GERD is seen for initial evaluation, THEN the patient should be assessed for the presence or absence of the following alarm symptoms: involuntary weight loss, dysphagia, and GI bleeding.* | Round 1: 8.5 (8, 8, 8, 8, 9, 9, 9, 9) |
| IF a patient with a diagnosis of GERD has at least one alarm symptom, THEN upper endoscopy should be performed.*† | Round 1: 9.0 (8, 9, 9, 7, 9, 9, 9, 9) |
| IF a patient with GERD is overweight or obese, THEN weight loss should be advised. | Round 1: 8.0 (9, 8, 8, 9, 8, 8, 8, 9) |
| IF a patient with GERD has an endoscopy report that indicates a suspicion of Barrett's esophagus, THEN suspicious areas should be biopsied.*† | Round 1: 9.0 (8, 9, 8, 9, 9, 9, 9, 9) |
| IF a patient with GERD has troublesome dysphagia, THEN endoscopy with biopsy should be performed. Biopsies should target any areas of suspected metaplasia, dysplasia, or in the absence of visual abnormalities, normal mucosa (4 biopsies from both proximal and distal esophagus to rule out eosinophilic esophagitis).† | Round 1: 9.0 (8, 8, 8, 9, 9, 9, 9, 9) |
| Monitoring (n=2) | |
| IF a patient with GERD is prescribed chronic PPI or H2RAs, THEN the patient should receive an assessment of their GERD symptoms within 12 months.* | Round 1: 7.5 (8, 6, 7, 7, 2, 9, 9, 8) Round 2: 8.0 (8, 7, 7, 7, 8, 8, 9, 9) |
| IF a patient with GERD is prescribed an initial empiric trial of PPI, THEN the patient should have scheduled follow-up within 4 to 12 weeks.‡ | Round 1: Measure did not exist Round 2: 8.0 (9, 8, 7, 8, 9, 9, 8, 9) |
| PPI-Refractory Symptoms (n=1) | |
| IF a patient has refractory typical GERD symptoms despite twice daily PPI and adherence to PPI, THEN an upper endoscopy should be performed to exclude non-GERD etiologies.† | Round 1: 9.0 (9, 9, 9, 9, 9, 9, 9, 9) |
| Chest Pain (n=1) | |
| IF a patient has chest pain, THEN a cardiac cause should be excluded before the commencement of a gastrointestinal evaluation. | Round 1: 9.0 (9, 9, 7, 9, 7, 8, 9, 9) |
| Erosive Esophagitis (n=3) | |
| IF erosive esophagitis is seen on endoscopy, THEN findings should be classified according to the Los Angeles (LA) classification system.† | Round 1: 9.0 (9, 9, 8, 9, 9, 9, 7, 9) |
| See supplemental table measures #41 & #42. (Combination of proposed measures). | |
| IF a patient has LA grade B or greater erosive esophagitis, THEN at least an 8-week course of PPI is the therapy of choice for symptom relief and healing.† | Round 1: 9.0 (9, 9, 8, 1, 9, 9, 9, 8) Round 2: 9.0 (9, 9, 9, 8, 9, 9, 9, 9) |
| IF a patient has LA grade C or D erosive esophagitis, THEN repeat endoscopy should be performed after a course of antisecretory therapy to exclude underlying Barrett's esophagus.† | Round 1: 7.0 (7, 7, 7, 6, 9, 8, 8, 7) Round 2: 8.5 (9, 8, 8, 8, 9, 8, 9, 9) |
| Stricture/Ring (n=1) | |
| IF a patient has a peptic stricture, THEN maintenance PPI therapy is recommended following stricture dilation to reduce the need for repeated dilations. | Round 1: 8.0 (8, 8, 8, 8, 9, 9, 9, 8) |
*
Denotes overlap with existing Agency for Healthcare Research and Quality Performance Measures
†
Initial proposed measure was reworded during the two rounds
‡
New measure developed by the expert panel in Round 2
GERD: Gastroesophageal Reflux Disease; PPI Proton Pump Inhibitor; H2RA: H2 Receptor Antagonist.