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Browsing by Author "Leiman, David A."
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Item AGA Institute Quality Indicator Development and Uses(Elsevier, 2023) Sheth, Sunil G.; Maratt, Jennifer K.; Newberry, Carolyn; Hung, Kenneth W.; Henry, Zachary; Leiman, David A.; Medicine, School of MedicineThe Affordable Care Act, which was signed into law in 2010, established several national priorities for health care delivery, including reinforcing the importance of high-value health care. Cost and quality are fundamental functions of value. Although costs may be clearly definable, quality can be more elusive to calculate and measure. The use of structured quality measures, which are standardized tools to quantify health care processes and outcomes, can reduce variability in quality reporting. One prominent example of a gastroenterology-focused quality measure is the adenoma detection rate, which reflects the percentage of average-risk screening colonoscopies in which at least 1 adenoma is detected. Like adenoma detection rate, all quality measures require discrete specifications for calculating a numerator and denominator to allow widespread standardization and reliable measurement across practices. Ultimately, this reproducibility permits the establishment of benchmark targets, which in turn allow insights into variable measure adherence and opportunity to develop and implement improvement.Item AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19(Elsevier, 2020-11-23) Leiman, David A.; Maratt, Jennifer K.; Ketwaroo, Gyanprakash A.; Medicine, School of MedicineThis document presents the official recommendations of the American Gastroenterological Association (AGA) regarding quality measures related to the diagnosis and management of the novel coronavirus, SARS-CoV-2. The current report outlines the process by which the Quality Committee (QC) evaluates guidance statements published by the AGA’s Clinical Guidelines Committee (CGC) to inform measure development. The recommendations discussed in this report relate to what remains an unprecedented event in contemporary history with unique challenges for CGC guidance-related measure development. The following recommendations were developed by the QC in consultation with the CGC. Their development was fully funded by the AGA Institute, with no additional outside funding.Item AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia with Helicobacter pylori(ScienceDirect, 2022) Hung, Kenneth W.; Maratt, Jennifer K.; Cho, Won Kyoo; Shah, Brijen J.; Anjou, Chioma I.; Leiman, David A.; Regenstrief Institute, School of MedicineGastric cancer is the third leading cause of cancer-related deaths worldwide, with more than 1 million incident cases diagnosed globally. 1 Non-cardia intestinal-type gastric cancer, the most common subtype of gastric cancer, develops through the Correa cascade in which chronic inflammation of normal gastric mucosa leads to atrophic gastritis, followed by gastric intestinal metaplasia (GIM), dysplasia, and ultimately gastric cancer. 2 GIM has an estimated prevalence of 4.8% in the United States based on an analysis of gastric biopsies from a large pathology database, but higher rates of GIM have been reported in certain racial and ethnic groups (14.8% in Asian Americans, 18.2% in Native Americans, 25.5% in African Americans, and 29.5% in Hispanic Americans). 3 ,4 Additional risk factors for GIM include tobacco use, autoimmune gastritis, and living or immigrating from an endemic area. The annual risk of progression from GIM to non-cardia intestinal-type gastric cancer is 0.16%, and factors such as persistent Helicobacter pylori infection, family history, anatomic extent and location of GIM, and histologic subtypes may confer increased risk of progression to gastric cancer. 5 Studies of U.S. endoscopists show variation in the management of patients with GIM, including use and interval for endoscopic surveillance, prompting the development of guidelines for the management of GIM.