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[质量保证的价值与形式:现实与一厢情愿之间的眼科及玻璃体内治疗]

[Value and formats of quality assurance : Ophthalmology and intravitreal therapy between reality and wishful thinking].

作者信息

Eter Nicole, Pauleikhoff Daniel, Agostini Hansjürgen, Fleckenstein Monika, Ziemssen Focke

机构信息

Universitätsaugenklinik Münster, Münster, Deutschland.

Augenzentrum, St. Franziskus-Hospital Münster, Münster, Deutschland.

出版信息

Ophthalmologe. 2020 Apr;117(4):298-306. doi: 10.1007/s00347-020-01064-y.

Abstract

BACKGROUND

In view of the large number of patients and error-prone activities, legal requirements for quality assurance (QA) are of great importance for modern ophthalmology.

OBJECTIVE

This article discusses the need and formats of QA using the example of intravitreal operative medication injection therapy (IVOM).

MATERIAL AND METHODS

The legal framework conditions are briefly referenced and improvement potentials of the status quo are discussed.

RESULTS

The first quality control instruments were implemented for IVOM therapy; however, important quality indicators (number of treatments per patient/year, loss of follow-up, course of function) are not yet evaluated nationwide in Germany and cannot therefore be taken into account for continuous improvement and QA reports. To date, not all ophthalmologists involved have been under review in the field of basic diagnostics and follow-up. Limiting QA to ophthalmic surgeons alone does not improve quality and many statutory health insurances actively prevent scientific investigations within selective contracts.

CONCLUSION

For the QA of imaging diagnostics, similar proficiency measures (random samples, round robin testing) are required in ophthalmology as in radiological disciplines. The communication of transparent quality indicators can reduce the risk in the medium term. The quality of treatment and results must not be left to chance, cost pressure or convenience. The manufacturers of software and diagnostic equipment should be oriented towards radiology, where the exchange of voxel-oriented image formats is now less and less hindered by proprietary formats.

摘要

背景

鉴于患者数量众多且存在易出错的操作,质量保证(QA)的法律要求对现代眼科至关重要。

目的

本文以玻璃体内手术药物注射治疗(IVOM)为例,探讨质量保证的必要性和形式。

材料与方法

简要提及法律框架条件,并讨论现状的改进潜力。

结果

已为IVOM治疗实施了首批质量控制工具;然而,重要的质量指标(每位患者每年的治疗次数、失访情况、功能进程)在德国尚未在全国范围内进行评估,因此无法用于持续改进和质量保证报告。迄今为止,并非所有参与的眼科医生在基础诊断和随访领域都受到审查。仅将质量保证局限于眼科外科医生并不能提高质量,而且许多法定医疗保险积极阻止在选择性合同范围内进行科学调查。

结论

对于成像诊断的质量保证,眼科与放射学科一样,需要类似的熟练度测量方法(随机抽样、循环检验)。透明质量指标的交流从中期来看可以降低风险。治疗质量和结果绝不能听天由命、受成本压力或便利性的影响。软件和诊断设备制造商应向放射学看齐,目前在放射学领域,基于体素的图像格式交换越来越少受到专有格式的阻碍。

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