Zeppernick Felix, Zeppernick Magdalena, Janschek Elisabeth, Wölfler Monika, Bornemann Sebastian, Holtmann Laura, Oehmke Frank, Brandes Iris, Scheible Chi Mi, Salehin Darius, Pethick Sigrid Vingerhagen, Boosz Alexander Stephan, Krämer Bernhard, Sillem Martin, Bühler Klaus, Keckstein Jörg, Schweppe Karl Werner, Meinhold-Heerlein Ivo
UKGM, Zentrum für Frauenheilkunde Gießen, Gießen, Germany.
LKH Villach, Villach, Austria.
Geburtshilfe Frauenheilkd. 2020 Feb;80(2):179-189. doi: 10.1055/a-1068-9260. Epub 2020 Feb 21.
Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patients' medical history, some centers (6.6 - 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.
子宫内膜异位症影响着大量年轻的绝经前女性。除了医学上的挑战外，子宫内膜异位症对医疗保健和社会保障系统来说也是一项重大负担。此前，子宫内膜异位症治疗的标准化质量指标尚未得到系统验证。为此启动了三阶段研究QS ENDO，以记录并改善实际情况和护理质量。其目标之一是创建子宫内膜异位症诊断和治疗的质量指标。在QS ENDO Real的第一阶段，向欧洲德语区（DACH地区）的所有1014个妇科科室发送了信件，其中包含一份问卷，作为调查当前护理状况的一种方式。总共296个（29.2%）收到问卷的中心参与了此次调查。对已完成问卷的后续评估表明，大多数子宫内膜异位症患者（根据数据估计约为60%）并非在获得SEF认证的医院接受治疗。指南建议使用特定的分类系统（rASRM、ENZIAN），但根据医院提供的护理水平，只有约44.4%至66.4%的科室使用rASRM评分，只有27%的医院使用ENZIAN分类系统来描述深部浸润性子宫内膜异位症。在询问患者病史时，一些中心（6.6 - 17.9%）认为关于诸如排便困难、排尿困难和性交困难等主要症状的问题不重要。QS ENDO Real首次使得了解欧洲德语区为子宫内膜异位症患者提供护理的实际情况成为可能。研究结果表明，国际指南中推荐作为护理金标准的几项措施仅用于部分患者的治疗。在这方面，需要做出更多努力来提供更高级的培训。治疗方法必须以指南为基础，在未经认证的中心也是如此，以提高子宫内膜异位症患者治疗的护理质量。
