Gastrointestinal Directorate, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK.
Colorectal Dis. 2011 Aug;13(8):939-43. doi: 10.1111/j.1463-1318.2010.02344.x. Epub 2010 Jun 2.
The aim of this study was to describe an easy and reproducible method of measuring clinical performance in colonoscopy.
Data from all endoscopy procedures performed within the main endoscopy unit at Derriford Hospital between January and December 2007 were analysed. Points were allocated for given procedures. A local health economic analysis revealed that at least 8 points (or four colonoscopies) must be performed to meet list costs. The clinical performance was described as a capability index of crude Caecal Intubation Rate (CIR) vs the mean Points Performed/Endoscopy List (points/list).
Overall, 3884 colonoscopies were performed, with a mean crude CIR of 89.6% and 8.3 points/List. Only 7/23 endoscopists consistently met the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) standard in a cost-effective way. An annual colonoscopy rate of ≥ 150 cases was associated with higher points per list (points/list) (P = 0.003). Endoscopists offering ≥ 15% of cases as training cases had significantly higher crude CIRs and points/list (P = 0.051; P = 0.017).
Clinical performance is a function of quality provided in a cost-effective way. Our capability index is an effective and reproducible way of measuring clinical performance. Training was not associated with reduced volume.
本研究旨在描述一种测量结肠镜检查临床绩效的简单且可重复的方法。
分析了 2007 年 1 月至 12 月期间在 Derriford 医院主要内镜科进行的所有内镜检查程序的数据。为给定的程序分配了分数。当地卫生经济学分析显示，至少要进行 8 分（或 4 次结肠镜检查）才能满足清单成本。临床绩效被描述为粗盲肠插管率（CIR）与每内窥镜列表分数（points/list）的能力指数。
总体而言，进行了 3884 次结肠镜检查，粗 CIR 平均为 89.6%，每列表分数为 8.3 分。只有 7/23 名内镜医生以具有成本效益的方式始终符合联合胃肠内镜咨询组（JAG）标准。每年结肠镜检查率≥150 例与每列表分数更高相关（points/list）（P=0.003）。提供≥15%的培训病例的内镜医生的粗 CIR 和 points/list 显著更高（P=0.051；P=0.017）。
临床绩效是提供具有成本效益的质量的函数。我们的能力指数是衡量临床绩效的有效且可重复的方法。培训与降低工作量无关。
