Colorectal Cancer Screening Quality Measures: Beyond Colonoscopy

Medicine in the United States is undergoing fundamental changes that will continue despite 2016 presidential election results. Changes include consolidation of provider networks, movement from volume to value-based reimbursement, demands for price and quality transparency, and a shift from focusing solely on individual physician-patient interactions to a broader triple aim focus that incorporates individual patients, population, health, and cost. These concepts all were articulated in the inaugural "Practice Management: The Road Ahead" article (Allen JI. The Road Ahead. Clin Gastroenterol Hepatol 2012; 10: 692-696). In this month's Road Ahead column, Sameer Saini and colleagues suggest that we broaden our view of colorectal cancer screening quality metrics from a colonoscopy-centric focus to a focus on the bottom line: do we reduce cancer in the population of patients that we serve? When we extend our view to a population level, we use current colonoscopy registries only as internal process controls. A successful health system will develop a mechanism to assess and demonstrate how well the collective team of providers accomplishes the only outcome that matters to patients: preventing colon cancer.