? ? Pressure to improve the quality and lower the cost of health care has created the need to understand the effectiveness of medical interventions in clinical practice settings. Endoscopy plays an n important role in the diagnosis and management of digestive diseases. Despite widespread use of endoscopy, little is known about outcomes in community-based settings. We developed a practice-based consortium to study endoscopic outcomes. Practice sites utilize a computerized endoscopic report generator to produce endoscopy reports, while simultaneously creating a data file. De-identified endoscopy data is transmitted electronically from sites to a central data repository for data analysis. Quality control measures ensure data integrity and accuracy. The practice consortium now includes 648 physicians in 68 adult, and 11 pediatric practice sites in 28 states. Of all adult endoscopy results, 65 % come from non-academic settings. We have demonstrated successful completion of prospective research projects. In the current proposal, we will build on the foundation of our clinical practice network, to conduct research, which will improve the quality of clinical practice in gastroenterology. The specific themes of this proposal are: Theme 1: Analysis of practice. We will conduct prospective analysis of endoscopic utilization, measure endoscopic findings and complications, practice variation, and identify association, which predict likelihood of favorable or unfavorable outcomes. Theme 2: Translation of research into practice. We will conduct research projects to translate new information about endoscopic outcomes into clinical practice. The consortium provides a unique opportunity to determine hoe new discovery impacts practice. Theme 3: Prospective research. Prospective research will focus on areas of clinical practice that lack critical evidence of effectiveness. We have developed methods for collection of prospective data in the flow of practice, following patient outcomes over time, and measuring changes in practice over time. Theme 4: Provide a resource to the scientific community. We have demonstrated successful collaboration with a wide range of clinical investigators to develop projects that are uniquely suited to a large community-based practice network. ? ?
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