The impact of practice guidelines in the management of Barrett esophagus: a national prospective cohort study of physicians.

M. Cruz-Correa, C. P. Gross, M. I. Canto, M. Cabana, R. E. Sampliner, J. P. Waring, C. McNeil-Solis, N. R. Powe

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

BACKGROUND: Surveillance of patients with Barrett esophagus (BE) is recommended to detect dysplasia and early cancer. In 1998, practice guidelines for the surveillance of patients with BE were developed under the auspices of the American College of Gastroenterology (ACG). Our objective is to assess physicians' awareness of agreement with and adherence to these guidelines. METHODS: A national prospective cohort study of practicing gastroenterologists who completed a self-administered questionnaire containing case studies prior to the release of the guidelines and another survey 18 months later. Analysis of adherence to the guidelines was done using the McNemar chi(2) test. RESULTS: Of the 154 gastroenterologists (66%) who responded to the follow-up survey, more than half (55%) were aware of the guidelines, and members of the ACG were more likely to know of their existence than nonmembers (61% vs 38%; P =.01). Overall, about 27% of physicians reported practicing in accordance with the guidelines at baseline; adherence increased modestly to 38% in the 18-month follow-up (P =.04) and was inversely related to fee-for-service reimbursement. Awareness was not associated with an increased likelihood of adherence, but agreement with the guidelines was strongly correlated with adherence (P<.001). The most frequent reasons for disagreement were concerns about liability, cancer risk, and inadequate evidence. CONCLUSIONS: Awareness of the guidelines published by the ACG was low. Guideline awareness did not predict adherence. Improvement in guideline adherence will require steps beyond mere dissemination and promotion. Addressing disagreements about liability, disease risk, and scientific evidence as well as restructuring payment incentives may help achieve optimal practice.

Original languageEnglish (US)
Pages (from-to)2588-2595
Number of pages8
JournalArchives of internal medicine
Volume161
Issue number21
DOIs
StatePublished - Nov 26 2001
Externally publishedYes

Fingerprint

Barrett Esophagus
Practice Guidelines
Cohort Studies
Prospective Studies
Guidelines
Physicians
Guideline Adherence
Gastroenterology
Fee-for-Service Plans
Motivation
Neoplasms
Surveys and Questionnaires

ASJC Scopus subject areas

  • Internal Medicine

Cite this

The impact of practice guidelines in the management of Barrett esophagus : a national prospective cohort study of physicians. / Cruz-Correa, M.; Gross, C. P.; Canto, M. I.; Cabana, M.; Sampliner, R. E.; Waring, J. P.; McNeil-Solis, C.; Powe, N. R.

In: Archives of internal medicine, Vol. 161, No. 21, 26.11.2001, p. 2588-2595.

Research output: Contribution to journalArticle

Cruz-Correa, M. ; Gross, C. P. ; Canto, M. I. ; Cabana, M. ; Sampliner, R. E. ; Waring, J. P. ; McNeil-Solis, C. ; Powe, N. R. / The impact of practice guidelines in the management of Barrett esophagus : a national prospective cohort study of physicians. In: Archives of internal medicine. 2001 ; Vol. 161, No. 21. pp. 2588-2595.
@article{85eba67ecc354f489e7a7137adf9363f,
title = "The impact of practice guidelines in the management of Barrett esophagus: a national prospective cohort study of physicians.",
abstract = "BACKGROUND: Surveillance of patients with Barrett esophagus (BE) is recommended to detect dysplasia and early cancer. In 1998, practice guidelines for the surveillance of patients with BE were developed under the auspices of the American College of Gastroenterology (ACG). Our objective is to assess physicians' awareness of agreement with and adherence to these guidelines. METHODS: A national prospective cohort study of practicing gastroenterologists who completed a self-administered questionnaire containing case studies prior to the release of the guidelines and another survey 18 months later. Analysis of adherence to the guidelines was done using the McNemar chi(2) test. RESULTS: Of the 154 gastroenterologists (66{\%}) who responded to the follow-up survey, more than half (55{\%}) were aware of the guidelines, and members of the ACG were more likely to know of their existence than nonmembers (61{\%} vs 38{\%}; P =.01). Overall, about 27{\%} of physicians reported practicing in accordance with the guidelines at baseline; adherence increased modestly to 38{\%} in the 18-month follow-up (P =.04) and was inversely related to fee-for-service reimbursement. Awareness was not associated with an increased likelihood of adherence, but agreement with the guidelines was strongly correlated with adherence (P<.001). The most frequent reasons for disagreement were concerns about liability, cancer risk, and inadequate evidence. CONCLUSIONS: Awareness of the guidelines published by the ACG was low. Guideline awareness did not predict adherence. Improvement in guideline adherence will require steps beyond mere dissemination and promotion. Addressing disagreements about liability, disease risk, and scientific evidence as well as restructuring payment incentives may help achieve optimal practice.",
author = "M. Cruz-Correa and Gross, {C. P.} and Canto, {M. I.} and M. Cabana and Sampliner, {R. E.} and Waring, {J. P.} and C. McNeil-Solis and Powe, {N. R.}",
year = "2001",
month = "11",
day = "26",
doi = "10.1001/archinte.161.21.2588",
language = "English (US)",
volume = "161",
pages = "2588--2595",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "21",

}

TY - JOUR

T1 - The impact of practice guidelines in the management of Barrett esophagus

T2 - a national prospective cohort study of physicians.

AU - Cruz-Correa, M.

AU - Gross, C. P.

AU - Canto, M. I.

AU - Cabana, M.

AU - Sampliner, R. E.

AU - Waring, J. P.

AU - McNeil-Solis, C.

AU - Powe, N. R.

PY - 2001/11/26

Y1 - 2001/11/26

N2 - BACKGROUND: Surveillance of patients with Barrett esophagus (BE) is recommended to detect dysplasia and early cancer. In 1998, practice guidelines for the surveillance of patients with BE were developed under the auspices of the American College of Gastroenterology (ACG). Our objective is to assess physicians' awareness of agreement with and adherence to these guidelines. METHODS: A national prospective cohort study of practicing gastroenterologists who completed a self-administered questionnaire containing case studies prior to the release of the guidelines and another survey 18 months later. Analysis of adherence to the guidelines was done using the McNemar chi(2) test. RESULTS: Of the 154 gastroenterologists (66%) who responded to the follow-up survey, more than half (55%) were aware of the guidelines, and members of the ACG were more likely to know of their existence than nonmembers (61% vs 38%; P =.01). Overall, about 27% of physicians reported practicing in accordance with the guidelines at baseline; adherence increased modestly to 38% in the 18-month follow-up (P =.04) and was inversely related to fee-for-service reimbursement. Awareness was not associated with an increased likelihood of adherence, but agreement with the guidelines was strongly correlated with adherence (P<.001). The most frequent reasons for disagreement were concerns about liability, cancer risk, and inadequate evidence. CONCLUSIONS: Awareness of the guidelines published by the ACG was low. Guideline awareness did not predict adherence. Improvement in guideline adherence will require steps beyond mere dissemination and promotion. Addressing disagreements about liability, disease risk, and scientific evidence as well as restructuring payment incentives may help achieve optimal practice.

AB - BACKGROUND: Surveillance of patients with Barrett esophagus (BE) is recommended to detect dysplasia and early cancer. In 1998, practice guidelines for the surveillance of patients with BE were developed under the auspices of the American College of Gastroenterology (ACG). Our objective is to assess physicians' awareness of agreement with and adherence to these guidelines. METHODS: A national prospective cohort study of practicing gastroenterologists who completed a self-administered questionnaire containing case studies prior to the release of the guidelines and another survey 18 months later. Analysis of adherence to the guidelines was done using the McNemar chi(2) test. RESULTS: Of the 154 gastroenterologists (66%) who responded to the follow-up survey, more than half (55%) were aware of the guidelines, and members of the ACG were more likely to know of their existence than nonmembers (61% vs 38%; P =.01). Overall, about 27% of physicians reported practicing in accordance with the guidelines at baseline; adherence increased modestly to 38% in the 18-month follow-up (P =.04) and was inversely related to fee-for-service reimbursement. Awareness was not associated with an increased likelihood of adherence, but agreement with the guidelines was strongly correlated with adherence (P<.001). The most frequent reasons for disagreement were concerns about liability, cancer risk, and inadequate evidence. CONCLUSIONS: Awareness of the guidelines published by the ACG was low. Guideline awareness did not predict adherence. Improvement in guideline adherence will require steps beyond mere dissemination and promotion. Addressing disagreements about liability, disease risk, and scientific evidence as well as restructuring payment incentives may help achieve optimal practice.

UR - http://www.scopus.com/inward/record.url?scp=0035956302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035956302&partnerID=8YFLogxK

U2 - 10.1001/archinte.161.21.2588

DO - 10.1001/archinte.161.21.2588

M3 - Article

C2 - 11718590

AN - SCOPUS:0035956302

VL - 161

SP - 2588

EP - 2595

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 21

ER -