Johns Hopkins University School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, Maryland, USA; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA.
Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
Gastrointest Endosc. 2019 Oct;90(4):651-655.e3. doi: 10.1016/j.gie.2019.06.004. Epub 2019 Jun 14.
There has been a tremendous increase in research focused on quality metrics in colonoscopy since 2000. However, whether national performance in colonoscopy quality outcomes has changed significantly since then is not as well known.
We examined colonoscopy data collected prospectively through the Clinical Outcomes Research Initiative, which included 84 GI practice sites from 2000 to 2014 for patients undergoing colonoscopy for multiple indications. Colonoscopy outcomes by indication were compared across three 5-year periods (2000-2004, 2005-2009, 2010-2014) using the following metrics: bowel preparation quality (percentage good/excellent), finding a polyp, finding 2 or more polyps, and finding a polyp >9 mm. Multivariate logistic regression was used to generate odds ratios and 95% confidence intervals for each time period while controlling for age, gender, and race/ethnicity.
A total of 1,541,837 adults were included in the study across all indication groups. The average-risk screening group (390,741 adults) demonstrated statistically significant improvement across all 4 quality metrics when comparing the baseline period with the final time period. Bowel preparation quality improved across all indications when comparing the baseline period with the final time period. Finding a polyp, finding 2 or more polyps, and finding a polyp >9 mm improved in the average-risk screening, surveillance, and diagnostic indication groups when comparing the baseline period with the final time period. The increased-risk screening and inflammatory bowel disease indication groups did not see improvements beyond bowel preparation quality when comparing the baseline with the final time period.
Colonoscopy outcomes as measured by bowel preparation quality, finding a polyp, finding 2 or more polyps, and finding a polyp >9 mm improved significantly over the 15-year period between 2000 and 2014, with the largest and most consistent impact in the average-risk screening indication group.
自 2000 年以来，针对结肠镜检查质量指标的研究呈指数级增长。然而，自那时以来，全国结肠镜检查质量结果的表现是否有显著变化尚不清楚。
我们通过临床结果研究倡议前瞻性地检查了结肠镜检查数据，该倡议包括 2000 年至 2014 年来自 84 个胃肠实践地点的患者，这些患者因多种指征而行结肠镜检查。通过以下指标比较了按指征划分的三个 5 年期间（2000-2004 年、2005-2009 年、2010-2014 年）的结肠镜检查结果：肠道准备质量（良好/优秀百分比）、发现息肉、发现 2 个或更多息肉以及发现 >9 毫米的息肉。使用多元逻辑回归生成每个时间段的优势比和 95%置信区间，同时控制年龄、性别和种族/民族。
共有 1541837 名成年人被纳入所有指征组的研究。在平均风险筛查组（390741 名成年人）中，与基线期相比，在比较最终时间时，所有 4 项质量指标均显示出统计学显著改善。在所有指征中，与基线期相比，肠道准备质量在最终时间时都有所改善。在平均风险筛查、监测和诊断指征组中，发现息肉、发现 2 个或更多息肉以及发现 >9 毫米的息肉均有所改善，而在比较基线期和最终时间时，增加风险的筛查和炎症性肠病指征组除了肠道准备质量之外没有任何改善。
在 2000 年至 2014 年的 15 年期间，以肠道准备质量、发现息肉、发现 2 个或更多息肉以及发现 >9 毫米的息肉等为衡量指标的结肠镜检查结果显著改善，在平均风险筛查指征组中，其影响最大且最一致。
