Evidence-Based Medicine
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2019; 25(8): 1024-1030
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.1024
Establishing a model to measure and predict the quality of gastrointestinal endoscopy
Luo-Wei Wang, Han Lin, Lei Xin, Wei Qian, Tian-Jiao Wang, Jian-Zhong Zhang, Qian-Qian Meng, Bo Tian, Xu-Dong Ma, Zhao-Shen Li
Luo-Wei Wang, Han Lin, Lei Xin, Wei Qian, Tian-Jiao Wang, Qian-Qian Meng, Zhao-Shen Li, Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
Jian-Zhong Zhang, Unimed Scientific Inc., Wuxi 214000, Jiangsu Province, China
Bo Tian, Department of Intensive Care Unit, Shanghai East Hospital, Tongji University, Shanghai 200120, China
Xu-Dong Ma, Department of Medical Quality, Medical and Health Administration, National Health Commission of China, Beijing 100044, China
Author contributions: Li ZS and Ma XD designed and supervised the study equally; Wang LW, Lin H and Xin L contributed equally, conducted this survey and wrote the manuscript; Qian W, Wang TJ, Zhang JZ, and Tian B collected and analyzed the data.
Conflict-of-interest statement: There are no conflicts of interest arising from this work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist and checked the manuscript accordingly.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhao-Shen Li, MD, Attending Doctor, Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai 200433, China. lizhaoshenmd@163.com
Telephone: +86-21-31161347 Fax: +86-21-55621735
Received: December 11, 2018
Peer-review started: December 11, 2018
First decision: January 6, 2019
Revised: January 15, 2019
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: February 28, 2019
Abstract
BACKGROUND

Tens of millions of gastrointestinal endoscopic procedures are performed every year in China, but the quality varies significantly and related factors are complex. Individual endoscopist- and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.

AIM

To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in mainland China.

METHODS

Selected data on endoscopy experience, equipment, facility, qualification of endoscopists, and other relevant variables were collected from the National Database of Digestive Endoscopy of China. The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance. Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.

RESULTS

In 2012, gastroscopy/colonoscopy-related complications in mainland China included bleeding in 4,359 cases (0.02%) and perforation in 914 (0.003%). Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases (0.3%), bleeding in 2,151 (1.10%), perforation in 257 (0.13%) and biliary infection in 4,125 (2.11%). Moreover, 1,313 (5.0%) endoscopists encountered with medical malpractice, and 5,243 (20.0%) encountered with the disturbance from patients. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance. However, the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.

CONCLUSION

The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. More comprehensive data are needed to establish quality-predictive models for endoscopic complications.

Keywords: Endoscopy, Gastroscopy, Colonoscopy, Endoscopic retrograde cholangiopancreatography, Quality control, Predictive model, Performance predictor

Core tip: Tens of millions of gastrointestinal endoscopic procedures are performed each year in China, but there is significant variation in the quality of endoscopy, and the method of measuring quality remains unknown. We collected data from the National Database of Digestive Endoscopy of China to establish a model to measure and predict the quality of gastrointestinal endoscopy in mainland China. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors of medical malpractice and patient disturbance. The length of experience and endoscopist/nurse ratio were not adequate to establish a model for the prediction of endoscopic complications.