Please cite this article in press as: Buri L, et al. How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre? Dig Liver Dis (2010), doi:10.1016/j.dld.2010.02.012 ARTICLE IN PRESS G Model YDLD-1670; No. of Pages 5 Digestive and Liver Disease xxx (2010) xxx–xxx Contents lists available at ScienceDirect Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld Digestive Endoscopy How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre? L. Buri a , G. Bersani b , C. Hassan c,∗ , M. Anti d , M.A. Bianco e , L. Cipolletta e , E. Di Giulio f , G. Di Matteo g , L. Familiari h , L. Ficano i , P. Loriga j , S. Morini c , V. Pietropaolo k , A. Zambelli l , E. Grossi m , M. Intraligi n , F. Tessari o , M. Buscema n , the SIED Appropriateness Working Group 1 a Gastroenterology and Digestive Endoscopy Unit, Cattinara Hospital, Trieste, Italy b Gastrointestinal Endoscopy Service, Malatesta, Cesena, Italy c Gastroenterology, Nuovo Regina Margherita, Rome, Italy d Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy e Division of Gastroenterology and Digestive Endoscopy ASL NA5-Hospital Agostino Maresca, Torre del Greco, Italy f Digestive and Liver Disease Unit, Second Medical School, University “La Sapienza”, Sant’Andrea Hospital, Rome, Italy g Gastroenterology Unit, “Saverio De Bellis” Hospital, Castellana Grotte, Bari, Italy h Gastroenterology, Policlinico G Martino, Messina, Italy i Surgery and Oncology Department, “Università di Palermo”, Palermo, Italy j Endoscopy Unit, SS Trinità Hospital, Cagliari, Italy k Gastroenterology Unit, Policlinico La Sapienza, Rome, Italy l Gastroenterology Unit, Maggiore Hospital, Crema, Italy m Bracco Imaging S.p.A., Medical Affairs Europe, Milan, Italy n Semeion Research Centre for Sciences of Communication, Rome, Italy o Idea99, Padova, Italy article info Article history: Received 17 November 2009 Accepted 15 February 2010 Available online xxx Keywords: Appropriateness Upper endoscopy abstract Background: Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres. Methods: A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre. Results: discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41–97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively. Conclusions: A simple predictive rule, based on rate of patients referred by GPs, rate of urgent exam- inations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs. © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. 1. Introduction Open-access upper endoscopy (EGD) is the most widespread access system to endoscopic examinations in the health systems ∗ Corresponding author at: Ospedale Nuovo Regina Margherita, Via Morosini 30, Rome, Italy. Tel.: +39 06 58446608; fax: +39 06 58446533. E-mail address: cesareh@hotmail.com (C. Hassan). 1 See Appendix A for the list of members. of the western world [1]. This type of service allows physicians to directly schedule elective, common endoscopic procedures for their patients without prior consultation. Unfortunately, this has also resulted in a considerable increase in both overall cost and waiting lists for EGD [2,3]. In order to optimise the use of finite resources in an open-access system, official guidelines for the appropriate use of EGD have been proposed by the American Society for Gastrointestinal Endoscopy (ASGE) and by the European Panel on the appropriateness of Gas- trointestinal Endoscopy (EPAGE) [4,5]. Previous studies based on 1590-8658/$36.00 © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2010.02.012