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
Research background

There are increasingly more gastrointestinal endoscopic procedures performed every year. However, there is significant variation in quality, and the causative factors are complex. Well-accepted predictive models have not been developed.

Research motivation

No related research has focused on this field in China before. However, the quality control of gastrointestinal endoscopy is an important issue. According to our national survey, we found that a number of adverse effects were related to gastrointestinal endoscopy. Therefore, we collected data from the National Database of Digestive Endoscopy of China, aiming to establish a model to measure and predict the quality of gastrointestinal endoscopy in mainland China.

Research objectives

Quality control is an important issue in gastrointestinal endoscopy. The primary objective of this study was to explore the feasibility of establishing a model to measure and predict the overall quality of endoscopic procedures in a system consisting of human resources as well as processes and equipment, rather than to measure the performance of specific endoscopic procedures.

Research methods

Related data were obtained from the nationwide survey in hospitals in all 31 provinces, autonomous regions and municipalities of mainland China in 2013. Multivariable logistic regression analyses were used to examine and identify the potential predictive variables for the occurrence of medical malpractice and patient disturbance.

Research results

In 2012, gastroscopy and colonoscopy-related complications included bleeding (0.02%) and perforation (0.003%). Endoscopic retrograde cholangiopancreatography (ERCP)-related complications included severe acute pancreatitis (0.3%), bleeding (1.10%), perforation (0.13%) and biliary infection (2.11%). Moreover, 5.0% of endoscopists encountered with medical malpractice and 20.0% encountered with the disturbance from patients or their relatives. Multivariable logistic regression analyses showed that five workload-related factors, including length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction, were predictors for 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 gastroscopy/colonoscopy or ERCP.

Research conclusions

In this study, we found for the first time that the workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. These findings suggest that in the clinical practice, decreasing the workload and increasing the welfare of endoscopists may improve the quality of gastrointestinal endoscopy.

Research perspectives

This study cannot build an ideal model for predicting the quality of gastrointestinal endoscopy. In the future, more comprehensive data are needed to establish quality-predictive models for endoscopic complications. The optimal method would be a multicenter prospective structured study.