Achalasia Quality Indicator Adherence.

BACKGROUND: Quality indicators (QIs) are formal ways to track health care performance and outcomes, guide quality improvement, and identify gaps in care delivery. We developed twelve quality indicators for achalasia management which cover the domains of patient education, diagnosis, and treatment of achalasia. AIM: To determine adherence to established quality indicators for achalasia management. METHODS: We performed a retrospective, multicenter evaluation of care patterns for adult patients greater than 18 years old with newly diagnosed achalasia from January 2018 to May 2020. A balanced random patient sample was obtained at four large academic medical centers. Independent electronic health record chart abstraction was performed using a standardized form to determine adherence to applicable QIs. Pooled and de-identified data were analyzed to identify gaps in care. RESULTS: A total of 120 patients were included and the overall adherence to applicable quality indicators across all centers was 86%. The median follow-up for all patients from time of diagnosis to end of study was 511 days. Clinicians adhered to all applicable quality indicators in 49 patients (39%). The quality indicator domain with the poorest adherence was patient education (67%), with 50% of patients having had a documented discussion of the risks of gastroesophageal reflux disease following surgical or endoscopic myotomy. CONCLUSIONS: Gaps in the quality of achalasia care delivery were identified, the largest of which relates to patient education about treatment risks. These findings highlight a potential area for future quality improvement studies and form the basis for developing fully specified quality measures.

Detection of p53 protein transcriptional activity by chromatin immunoprecipitation.

p53 is a key transcriptional mediator that controls the expression of hundreds of target genes necessary to maintain cellular homeostasis and genome integrity. An important cellular function that is dependent on p53 transcriptional activity is apoptosis or programmed cell death. Indeed, inhibition of p53 transcriptional activity is often observed in cancers as a result of mutations within its DNA-binding domain. In this chapter, we describe the use of chromatin immunoprecipitation and real-time quantitative polymerase chain reaction to detect p53 transcriptional activity in cancer cells and tumor tissues. This technique enables the determination of the ability of p53 to bind to the promoter region of apoptotic genes and to evaluate the transcription-dependent activity of p53-induced apoptosis.