Table 3.
Moderate-Validity GERD Care Quality Measures.
| Median Rankings (Individual panelist rankings) | |
|---|---|
| Initial Diagnosis & Management (n=2) | |
| IF a patient with non-erosive GERD experiences heartburn relief with H2RA therapy, THEN an H2RA can be used as a maintenance option. | Round 1: 8.0 (5, 8, 7, 9, 8, 8, 9, 9) |
| IF a patient has suspected GERD without dysphagia, THEN a barium radiograph should not be used as a diagnostic test.*,† | Round 1: 8.0 (8, 9, 9, 8, 8, 7, 9, 2) |
| Monitoring (n=1) | |
| IF PPIs have proven clinically effective for patients with GERD, THEN PPIs should be used long-term.† | Round 1: 8.0 (8, 6, 8, 8, 8, 8, 9, 8) |
| PPI-Refractory Symptoms (n=1) | |
| IF a patient has refractory GERD symptoms despite standard PPI therapy, THEN the first step in management is optimization of PPI therapy.† | Round 1: 8.0 (9, 9, 9, 1, 9, 9, 9, 8) |
| Further Diagnostic Testing (n=4) | |
| IF a patient with suspected troublesome GERD has not responded to empirical trial of PPI therapy, has normal findings on endoscopy, and has no major abnormalities on manometry, THEN ambulatory reflux monitoring off of PPI therapy for 7 days should be performed.† | Round 1: 8.0 (8, 9, 8, 7, 9, 9, 9, 5) |
| IF a patient has suspected GERD with disease refractory to PPI therapy and no findings of erosive disease on endoscopy, THEN ambulatory esophageal reflux monitoring off of PPI therapy for 7 days is indicated before consideration of endoscopic or surgical therapy. | Round 1: 9.0 (9, 9, 9, 9, 9, 9, 9, 6) |
| IF planning to perform reflux monitoring off of anti-reflux medication, THEN either pH or impedance-pH monitoring are sufficient to establish a GERD diagnosis.† | Round 1: 8.0 (8, 8, 8, 6, 9, 9, 9, 7) |
| IF planning to perform reflux monitoring on anti-reflux medication, THEN impedance-pH monitoring should be performed to enable measurement of persistent acid or nonacid reflux.† | Round 1: 8.5 (8, 9, 8, 6, 9, 9, 9, 7) |
| Surgical Therapy (n=2) | |
| IF a patient with GERD is refractory to medical therapy and has objective evidence of ongoing reflux as the cause of symptoms, THEN consideration should be given to anti-reflux surgery.† | Round 1: 8.0 (6, 8, 8, 8, 9, 9, 9, 8) |
| IF anti-reflux surgery and PPI therapy are judged to offer similar efficacy in a patient with an esophageal GERD syndrome, THEN PPI therapy should be recommended as initial therapy because of superior safety and long-term efficacy.† | Round 1: 8.0 (6, 8, 8, 9, 7, 8, 9, 8) |
*
Denotes overlap with existing Agency for Healthcare Research and Quality Performance Measures
†
Initial proposed measure was reworded during the two rounds
GERD: Gastroesophageal Reflux Disease; PPI Proton Pump Inhibitor; H2RA: H2 Receptor Antagonist.