Alharbi Othman, Rabeneck Linda, Paszat Lawrence, Wijeysundera Duminda N, Sutradhar Rinku, Yun Lingsong, Vinden Christopher M, Tinmouth Jill
Department of Medicine, Division of Gastroenterology, Sunnybrook Health Services Centre, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Can J Gastroenterol. 2010 Jul;24(7):419-24. doi: 10.1155/2010/151232.
Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.
To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.
The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.
An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).
Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.
结肠镜检查越来越多地在医院以外的机构进行。这些机构的监管情况各不相同，人们对非医院环境中检查程序的质量也提出了担忧。需要进一步研究以更好地了解这些机构中的内镜操作情况。
描述1993年至2005年安大略省基于非医院机构的结肠镜检查情况，并确定与这种操作相关的患者因素（年龄、性别、收入五分位数和合并症）和医生因素（专业和结肠镜检查量）。
本研究是一项基于人群的横断面分析，使用安大略省成年人的健康管理数据，这些成年人在1993年至2005年间至少接受过一次门诊结肠镜检查。共有1240781名患者接受了1917714次结肠镜检查。主要结局指标是在非医院机构接受结肠镜检查。
发现基于非医院机构的结肠镜检查从1993年的10.0%增加到2005年的15.1%（P<0.0001）。在多变量模型中，居住在高收入地区的年轻、健康男性接受基于非医院机构结肠镜检查的可能性显著更高。外科医生和其他从业者（如非胃肠病学家和非内科医生）在非医院环境中执业的可能性显著更高。结肠镜检查量最高的五分位数组的医生在非医院环境中执业的可能性是最低五分位数组医生的25倍（P<0.0001）。
安大略省基于非医院机构的结肠镜检查率正在上升。高结肠镜检查量的内镜医师和外科医生最有可能在非医院环境中执业。鉴于其使用越来越多，有必要对非医院结肠镜检查的操作和监管进行进一步研究。
