启动胃肠病学专科培训项目对结肠镜检查质量指标的影响。
Effects of Starting a Gastroenterology Fellowship Training Program on Quality Measures of Colonoscopy.
作者信息
Elhanafi Sherif, Chhana Rahul, Mallawaarachchi Indika, Lou Wynee, Rangel Gabriela, Fang Hongfei, Patel Rinkal, Dwivedi Alok Kumar, Zuckerman Marc J, Othman Mohamed O
机构信息
From the Department of Medicine, Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, the Department of Internal Medicine, Division of Gastroenterology, and the Department of Biomedical Sciences, Division of Biostatistics & Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, and the Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.
出版信息
South Med J. 2017 Mar;110(3):200-206. doi: 10.14423/SMJ.0000000000000614.
OBJECTIVES
Adenoma detection rate (ADR) is the most established indicator of the quality of screening colonoscopy. The effect of gastroenterology (GI) fellows on the quality of screening colonoscopies has been evaluated previously; however, the effect of starting a new GI fellowship program on the quality of screening colonoscopies has not been studied. The aim of our study was to assess the effects of starting a GI fellowship program and the participation of fellows in screening colonoscopies on ADR and other measures of quality.
METHODS
This was a retrospective, cross-sectional study of all screening colonoscopies performed 20 months before and 20 months after starting the GI fellowship at our medical center (November 2010-February 2014). Colonoscopy procedure notes and pathology records were reviewed for each patient. Data from the two periods were compared using either the Fisher exact test or the two-sample test.
RESULTS
A total of 2127 complete colonoscopies were included in the analysis. The mean age of patients was 58.8 ± 6.6 years. Of the 2127 colonoscopies, GI fellows were involved in 385 (18%), whereas 1742 (82%) were performed solely by GI attendings (attending physicians). Multivariate analysis using relative risk (RR) of regression was done. The after starting the GI fellowship period was significantly associated with an increase in ADR (RR 1.19, 95% confidence interval 1.10-1.30, < 0.001) and advanced adenoma detection rate (RR 1.17, 95% confidence interval 1.00-1.38, < 0.001) compared with the before starting the GI fellowship period. In the after starting the GI fellowship period, the polyp detection rate and ADR for colonoscopies performed by the attending physicians with the fellows were significantly higher than colonoscopies performed solely by the same attendings (58.4% vs 44.5%, = 0.001, 42.0% vs 32.9%, = 0.017, respectively).
CONCLUSIONS
Starting a GI fellowship program significantly increased the polyp detection rate, ADR, and advanced ADR.
目的
腺瘤检出率（ADR）是筛查结肠镜检查质量最公认的指标。此前已评估过胃肠病学（GI）住院医师对筛查结肠镜检查质量的影响；然而，启动一项新的GI住院医师培训项目对筛查结肠镜检查质量的影响尚未得到研究。我们研究的目的是评估启动GI住院医师培训项目以及住院医师参与筛查结肠镜检查对ADR和其他质量指标的影响。
方法
这是一项对在我们医疗中心启动GI住院医师培训项目之前20个月和之后20个月（2010年11月 - 2014年2月）进行的所有筛查结肠镜检查的回顾性横断面研究。对每位患者的结肠镜检查操作记录和病理记录进行了审查。使用Fisher精确检验或两样本检验对两个时期的数据进行比较。
结果
共有2127例完整的结肠镜检查纳入分析。患者的平均年龄为58.8±6.6岁。在这2127例结肠镜检查中，GI住院医师参与了385例（18%），而1742例（82%）仅由GI主治医师（主治医生）进行。使用回归相对风险（RR）进行了多变量分析。与启动GI住院医师培训项目之前的时期相比，启动GI住院医师培训项目之后的时期与ADR的增加显著相关（RR 1.19，95%置信区间1.10 - 1.30，P < 0.001）以及高级腺瘤检出率（RR 1.17，95%置信区间1.00 - 1.38，P < 0.001）。在启动GI住院医师培训项目之后的时期，由主治医师与住院医师一起进行的结肠镜检查的息肉检出率和ADR显著高于仅由相同主治医师进行的结肠镜检查（分别为58.4%对44.5%，P = 0.001，42.0%对32.9%，P = 0.017）。
结论
启动GI住院医师培训项目显著提高了息肉检出率、ADR和高级ADR。
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