What is a Performance Improvement Program and why is it important?

A Performance Improvement (P/I) Program is a proactive evaluation performed by a medical practice to monitor the quality of medical care and services they deliver. This is achieved by comparing measurable parameters to nationally recognized benchmarks. These benchmarks are derived from published medical literature and developed by medical and healthcare organizations.

Adhering or exceeding these benchmark standards suggests the delivery of the highest degree of clinical and endoscopic care resulting in the best, safest, and most economical outcome for our patients.

How do we compare?

What do we measure and what are our results?

Perhaps there is no better measurement as to how well you manage your patients than to ask them directly about how you "measure up". That's exactly what we do with our Patient Opinion Survey, conducted by an independent, outside, unbiased company and containing a list of questions which grade us from "check in to check out". This tool makes it easy to assess how we compare with other practices nationwide. We are proud of our results.

The survey evaluates five very critical areas: staff and physician communication with patients, environmental safety and comfort, office management, patient education, and physician/staff teamwork. We are graded on a scale of one to five with 1=poor, 2=fair, 3=good, 4=very good and 5=excellent. While we recognize that no one is perfect and that we can not please "all the people all the time", we are diligent in continuously striving toward that goal and feel that is reflected in our survey results. Our practice consistently receives grades of 4.5 or higher in all categories and even though each category is important, we would like to highlight a few responses we feel are very critical to patient satisfaction. When asked whether or not their doctor is familiar with their history, listens to them, is knowledgeable, appears concerned, is pleasant and is sensitive to their privacy; our patients consistently grade our physicians with average scores of 4.58. Our staff courtesy was rated 4.64 and our phone receptionist received a score of 4.62. Under office management, the areas of telephone calls returned in a timely fashion and appointments made when needed received an average score of 4.50. Our nurses received grades of 4.50 and 4.57 respectively for patient education and knowledge.

While we perform many different procedures in our Ambulatory Endoscopy Center, our P/I program focuses primarily on colonoscopy since that is the most frequent examination performed. That is not to say that we do not monitor such important parameters as infection control; patient safety, follow up and privacy; communication with referring physicians; and documentation of findings. However, we presently concentrate on monitoring and reviewing three parameters which recently have become nationally recognized indicators of quality performance. Since many colonoscopies are done for colon cancer screening, these indicators ensure our patients receive an exam that is thorough and complete and with enough dedicated time to minimize any possible oversight which could result in a negative outcome.

Documentation of visualizing the cecum (end of the colon) assures a complete examination. We are consistently over the national standards of 97% in reaching the cecum and therefore performing a complete colonoscopy and assuring our patients that their entire large bowel has been inspected.

Studies have shown increase detection of significant precancerous and cancerous lesions in the colon when colonoscopy withdrawal time corresponds with a minimal limit. Most of the inspection of the colonic lining is accomplished during withdrawal of the endoscope and the time the physician takes in withdrawal is imperative to a thorough examination diminishing the probability of missing a significant colonic neoplasm. We monitor our times and have consistently exceeded the national benchmark.

Most importantly, while complications are an unavoidable reality of medical procedures, we are proud to say that our rate of combined complications for all endoscopic procedures performed in our facility speaks highly for our physicians, nurses and staff. National statistics indicated major endoscopic complication rates for routine procedures of 0.2% (20 occurrences in 10,000 procedures). We are well below this benchmark with 0.08% (8 in 10,000) total complication rate in 2004 and 0.06% (6 in 10,000) in 2005 without any procedure related deaths. There are no complications reported in the first quarter of 2006.

In addition, our facility performed a randomized, double blinded, placebo controlled trial utilizing C02 (carbon dioxide) versus the standard air used during colonoscopy. The results revealed that using C02 to insufflate the colonic lumen was associated with less pain, bloating, and nausea resulting in improved post-procedural patient recovery. This study won the American College of Gastroenterology Presidential Poster Award for 2003. We now routinely use C02 with all our colonoscopies, thus improving patient comfort.