James Paul D, Hegagi Mae, Antonova Lilia, Tinmouth Jill, Heitman Steven J, Simone Carmine, Yeung Elaine, Yong Elaine
Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont.
CMAJ Open. 2017 Jun 7;5(2):E437-E443. doi: 10.9778/cmajo.20160153.
Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario.
We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography.
We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas.
Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs- and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province.
内镜超声检查是评估和处理肝胆及胃肠道疾病（恶性和非恶性）的一种安全且准确的方式；其应用正在增加。本研究的目的是描述安大略省内镜超声检查的使用区域趋势。
我们利用卫生行政数据库进行了一项基于人群的回顾性队列研究。我们使用医生计费数据确定了2003年至2011年在安大略省接受内镜超声检查的所有患者。对患者、医生和机构特征进行了检查。主要结局是内镜超声检查的使用情况。
我们确定了8001例患者接受了9076次内镜超声检查（3858名女性[48.2%]；首次检查时患者年龄中位数为59岁）。共有3066次检查（33.8%）涉及细针穿刺抽吸。在内镜超声检查的使用在研究期间增加了17倍。2011年，内镜超声检查使用率最高的健康区域的居民接受该检查的可能性是使用率最低的健康区域居民的4倍多（标准化率为每10万人61.6次对12.9次）。约十分之七的内镜超声检查在学术机构或区域癌症中心进行。在研究期间进行内镜超声检查的所有17位内镜医师均在城市地区执业。
尽管安大略省内镜超声检查的使用随时间增加，但在使用方面存在明显的区域差异。可能需要省级基于需求和证据的举措来缩小该省内镜超声服务提供方面的区域差距。
