Endoscopy plays an important role in the diagnosis and management of digestive diseases. It is estimated that more than 20 million endoscopic procedures are performed annually in the United States. The Clinical Outcomes Research Initiative (CORI) was developed in the 1990's to collect endoscopy data from diverse practice settings with goal of measuring utilization and outcomes to improve the practice of endoscopy. The consortium includes endoscopists in 70 practices, who use a computer to generate endoscopy reports which are sent electronically to a central data repository. The repository receives more than 260,000 reports annually. The consortium has completed both descriptive analyses of endoscopy practice and prospective studies. CORI has been funded by NIDDK since 1999, and produced 47 manuscripts in peer-reviewed journals covering a broad range of topics in endoscopy, and received other federal and foundation grants to support specific research projects.
The specific aim of the current proposal is to use the existing endoscopic data repository and consortium to perform research which will improve the quality of endoscopic practice. There are three primary themes. Theme 1: analysis of practice. These studies will identify opportunities for improving practice by first identifying current practice patterns, and measuring key endoscopic outcomes. We will determine """"""""best practices"""""""" and changes in practice over time. Theme 2: improving quality of endoscopic practice. We will measure endoscopic quality indicators and study the impact of interventions designed to achieve best practices. These interventions will include embedding educational guidelines into computer software and providing personal quality assurance reports to individual providers. Theme 3: This unique data repository will be a resource to the research and public health community in the United States and abroad.

Public Health Relevance

Endoscopy represents one of the most commonly performed invasive procedures in the United States. CORI has performed the first studies to measure the quality of endoscopic practice in diverse practice settings. The primary goals of the current proposal are to use the endoscopic database to monitor practice over time to identify areas for quality improvement, and to develop interventions to improve quality.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project--Cooperative Agreements (U01)
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Study Section
Special Emphasis Panel (ZDK1-GRB-C (M1))
Program Officer
Serrano, Jose
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Oregon Health and Science University
Internal Medicine/Medicine
Schools of Medicine
United States
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Mooers, Harrison M; Holub, Jennifer L; Lieberman, David A (2018) Screening Women Aged 50-59 for CRC Using Fecal Occult Blood Test Produces Outcomes Similar to Men Undergoing Screening Colonoscopy. Dig Dis Sci 63:2780-2785
Kluge, Matthew A; Williams, J Lucas; Wu, Connie K et al. (2018) Inadequate Boston Bowel Preparation Scale scores predict the risk of missed neoplasia on the next colonoscopy. Gastrointest Endosc 87:744-751
Holub, Jennifer L; Morris, Cynthia; Fagnan, Lyle J et al. (2018) Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network. J Rural Health 34 Suppl 1:s75-s83
Lin, Emery C; Holub, Jennifer; Lieberman, David et al. (2018) Low Prevalence of Suspected Barrett's Esophagus in Patients with Gastroesophageal Reflux Disease Without Alarm Symptoms. Clin Gastroenterol Hepatol :
Woodward, Zibing; Williams, J Lucas; Sonnenberg, Amnon (2016) Length of endoscopic workup in gastrointestinal bleeding. Eur J Gastroenterol Hepatol 28:1166-71
Saks, Karen; Enestvedt, Brintha K; Holub, Jennifer L et al. (2016) Colonoscopy Identifies Increased Prevalence of Large Polyps or Tumors in Patients 40-49 Years Old With Hematochezia vs Other Gastrointestinal Indications. Clin Gastroenterol Hepatol 14:843-849
Thakkar, Kalpesh; Holub, Jennifer L; Gilger, Mark A et al. (2016) Quality indicators for pediatric colonoscopy: results from a multicenter consortium. Gastrointest Endosc 83:533-41
Day, Lukejohn W; Nazareth, Michelle; Sewell, Justin L et al. (2015) Practice variation in PEG tube placement: trends and predictors among providers in the United States. Gastrointest Endosc 82:37-45
Childers, Ryan E; Williams, J Lucas; Sonnenberg, Amnon (2015) Practice patterns of sedation for colonoscopy. Gastrointest Endosc 82:503-11
Lieberman, David A; Williams, J Lucas; Holub, Jennifer L et al. (2014) Colonoscopy utilization and outcomes 2000 to 2011. Gastrointest Endosc 80:133-43

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