Xin Lei, Gao Ye, Cheng Zhiyuan, Wang Tianjiao, Lin Han, Pang Yanan, Sun Chang, Fu Zengjun, Li Zhaoshen, Ma Xudong, Wang Luowei
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
Graduate School, Naval Medical University, Shanghai 200433, China.
Chin Med J (Engl). 2022 Aug 20;135(16):2003-2010. doi: 10.1097/CM9.0000000000002366.
Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.
We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight.
From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.
Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.
近年来，在全球范围内，消化内镜检查的数量和可及性都有了显著发展，人们对质量保证的关注度也日益提高。我们调查了2015年至2019年中国消化内镜检查的使用情况和质量，并为医疗机构开发了一种定量质量评估工具。
我们每年邀请中国大陆所有三级/二级医院参与调查。问卷包括内镜检查的人员、年检查量和质量指标。基于记录的质量指标，采用主成分分析确定相对权重，制定了内镜质量指数（EQI）。
2015年至2019年，分别有806家、1412家、2644家、2468家和2541家医院参与了本研究。三级医院和二级医院的内镜年平均检查量分别从12445例增加到16206例（增长1.30倍）和从2938例增加到4255例（增长1.45倍）。诊断性结肠镜检查的增长最为明显（标准化后所有医院增长1.44倍）。在诊断性食管胃十二指肠镜检查中，所有食管癌和胃癌中早期癌症的比例分别从12.3%（55210/448861）增至17.7%（85429/482647），以及从11.4%（69411/608866）增至16.9%（107192/634235）。诊断性结肠镜检查的腺瘤检出率从14.9%（2118123/14215592）增至19.3%（3943203/20431104）。EQI模型包括12项质量指标，将总方差的64.9%（7.792/12）纳入一个综合指数。根据EQI测量结果，三级医院以及检查量较大或内镜医师较多的发达地区医院的内镜检查质量高于其他医院。
近年来，中国消化内镜检查在数量和质量方面都有了很大发展。EQI是一种很有前景的工具，可用于量化不同医院的内镜检查质量。
