建立一个测量和预测胃肠内镜质量的模型。
Establishing a model to measure and predict the quality of gastrointestinal endoscopy.
机构信息
Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
Unimed Scientific Inc., Wuxi 214000, Jiangsu Province, China.
出版信息
World J Gastroenterol. 2019 Feb 28;25(8):1024-1030. doi: 10.3748/wjg.v25.i8.1024.
BACKGROUND
Tens of millions of gastrointestinal endoscopic procedures are performed every year in China, but the quality varies significantly and related factors are complex. Individual endoscopist- and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.
AIM
To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in mainland China.
METHODS
Selected data on endoscopy experience, equipment, facility, qualification of endoscopists, and other relevant variables were collected from the National Database of Digestive Endoscopy of China. The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance. Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.
RESULTS
In 2012, gastroscopy/colonoscopy-related complications in mainland China included bleeding in 4,359 cases (0.02%) and perforation in 914 (0.003%). Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases (0.3%), bleeding in 2,151 (1.10%), perforation in 257 (0.13%) and biliary infection in 4,125 (2.11%). Moreover, 1,313 (5.0%) endoscopists encountered with medical malpractice, and 5,243 (20.0%) encountered with the disturbance from patients. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance. However, the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.
CONCLUSION
The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. More comprehensive data are needed to establish quality-predictive models for endoscopic complications.
背景
中国每年进行数千万例胃肠道内镜检查，但质量差异很大，相关因素复杂。个体内镜医生和内镜科室相关因素可能有助于建立衡量和预测内镜质量的模型。
目的
建立一种衡量和预测中国大陆胃肠道内镜检查质量的模型。
方法
从中国消化内镜数据库中收集了与内镜经验、设备、设施、内镜医生资质等相关变量的数据。采用多变量逻辑回归分析确定发生医疗事故和患者干扰的潜在预测变量。采用线性和非线性回归建立预测内镜并发症发生率的模型。
结果
2012 年，中国大陆胃镜/结肠镜相关并发症包括出血 4359 例（0.02%），穿孔 914 例（0.003%）。内镜逆行胰胆管造影相关并发症包括急性重症胰腺炎 593 例（0.3%），出血 2151 例（1.10%），穿孔 257 例（0.13%），胆道感染 4125 例（2.11%）。此外，1313 名（5.0%）内镜医生遇到医疗事故，5243 名（20.0%）遇到患者干扰。内镜经验长度、每周工作小时数、每周夜班数、年假天数和工作满意度是发生医疗事故和患者干扰的预测因素。然而，内镜经验长度和内镜医生与护士的比例不足以建立有效的内镜并发症预测模型。
结论
内镜医生的工作量和工作满意度是医疗事故或患者干扰的有价值的预测因素。需要更全面的数据来建立内镜并发症的质量预测模型。
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