Njie Cheikh, Richman Courtney, Rebhun Jeffrey, Achalu Sudharshan, Kamal Afrin N, Otaki Fouad, Leiman David A, Kathpalia Priya
Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
Department of Medicine, Duke University, Durham, NC, USA.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae055.
Quality indicators (QIs) are standardized metrics that can be used to quantify health care delivery and identify important areas for practice improvement. Nine QIs pertaining to the diagnosis and management of eosinophilic esophagitis (EoE) were recently established. We therefore aimed to identify existing gaps in care using these QIs. This is a retrospective, multicenter study utilizing recently established EoE QIs to evaluate practice patterns among adult gastroenterologists in the diagnosis and management of EoE. Three patient cohorts of 30 patients each presenting with dysphagia, food impaction, and new diagnosis of EoE, respectively, were obtained, yielding 120 patients per site to assess for every QI. Summary statistics were reported across two main themes: diagnosis and management. Subsequent analysis of gaps in care was then performed. The domain of diagnosis of EoE (QI 1 and 2) had the most notable gap in care with only 55% of the presenting patients undergoing appropriate evaluation for EoE. The domain of management of EoE had overall higher QI fulfillment-however it also contained significant intra-category variation in care. Notably, while 79% of patients had clinical follow-up within 1 year from remission, only 54% underwent surveillance endoscopy within 2 years of remission. In contrast, 100% of patients with symptomatic strictures independent of histologic response underwent endoscopic dilation (QI 4). Management approaches for EoE are evolving and variation in care delivery exists. We identified significant gaps in both diagnosis of EoE especially amongst patients presenting with index food impaction and long term management of EoE, when retrospectively evaluating care patterns using newly established QIs. This is the first study of its kind to utilize these previously established QIs to objectively identify care gaps that exist in EoE amongst several institutions. These findings also highlight the importance of QIs and standardization of management of complex chronic diseases like EoE to help bridge these gaps and provide a framework to measure adherence to these best practices.
质量指标（QIs）是标准化的指标，可用于量化医疗服务提供情况并确定实践改进的重要领域。最近制定了九个与嗜酸性食管炎（EoE）的诊断和管理相关的质量指标。因此，我们旨在利用这些质量指标来识别现有护理差距。这是一项回顾性多中心研究，利用最近制定的EoE质量指标来评估成年胃肠病学家在EoE诊断和管理方面的实践模式。分别获得了三个患者队列，每个队列30名患者，分别表现为吞咽困难、食物嵌塞和新诊断的EoE，每个站点有120名患者用于评估每个质量指标。汇总统计数据按两个主要主题报告：诊断和管理。然后对护理差距进行后续分析。EoE诊断领域（质量指标1和2）的护理差距最为明显，只有55%的就诊患者接受了适当的EoE评估。EoE管理领域的质量指标总体完成率较高——然而，该领域在护理方面也存在显著的类别内差异。值得注意的是，虽然79%的患者在缓解后1年内进行了临床随访，但只有54%的患者在缓解后2年内接受了监测性内镜检查。相比之下，100%有症状性狭窄且与组织学反应无关的患者接受了内镜扩张（质量指标4）。EoE的管理方法正在不断发展，护理提供方面存在差异。当我们使用新制定的质量指标回顾性评估护理模式时，我们发现EoE的诊断存在显著差距，尤其是在初次出现食物嵌塞的患者中，以及EoE的长期管理方面。这是同类研究中首次利用这些先前制定的质量指标来客观识别多个机构中EoE存在的护理差距。这些发现还强调了质量指标以及EoE等复杂慢性病管理标准化的重要性，以帮助弥合这些差距并提供一个框架来衡量对这些最佳实践的遵循情况。
