Lightdale Jenifer R, Walsh Catharine M, Narula Priya, Utterson Elizabeth C, Tavares Marta, Rosh Joel R, Riley Matthew R, Oliva Salvatore, Mamula Petar, Mack David R, Liu Quin Y, Lerner Diana G, Leibowitz Ian H, Jacobson Kevan, Huynh Hien Q, Homan Matjaž, Hojsak Iva, Gillett Peter M, Furlano Raoul I, Fishman Douglas S, Croft Nicholas M, Brill Herbert, Bontems Patrick, Amil-Dias Jorge, Kramer Robert E, Ambartsumyan Lusine, Otley Anthony R, McCreath Graham A, Connan Veronik, Thomson Mike A
Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States.
Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J Pediatr Gastroenterol Nutr. 2022 Mar 1;74(S1 Suppl 1):S16-S29. doi: 10.1097/MPG.0000000000003263.
There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement.
With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach.
The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards).
The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.
内镜检查设施的差异对操作质量和结果的影响在国际上得到越来越多的认可。通过使用标准化评级量表来评估区域和国家层面内镜检查设施的质量，以发现改进机会的先例也越来越多。
在北美和欧洲儿科胃肠病学、肝病学和营养学会（NASPGHAN和ESPGHAN）的支持下，儿科内镜质量改进网络（PEnQuIN）的一个国际工作组采用研究与评价指南评估（AGREE）II工具的方法策略，制定了与评估为儿童提供内镜护理的设施质量相关的标准和指标。通过迭代的在线德尔菲法和随后的面对面会议达成了共识。根据GRADE（推荐评估、制定和评价分级）方法对证据质量和推荐强度进行评级。
PEnQuIN工作组就支持儿科内镜检查的设施的27项标准以及10项可用于识别儿童高质量内镜护理的指标达成了共识。这些标准被细分为三个子领域：临床操作质量（15项标准，5项指标）；患者和护理人员体验（9项标准，5项指标）；以及工作人员（3项标准）。
严格的PEnQuIN流程成功产生了可用于普遍指导和衡量全球范围内为儿童进行内镜检查的高质量设施的标准和指标。它还强调了目前儿科内镜护理流程证据的匮乏，以及对该临床领域进行研究的必要性。
