结肠镜的正式质量框架的成本和益处:经济评估
Sahar Pakneshan1,2, Naomi Moy3, Sam O'Connor3,4
1Department of Gastroenterology and Hepatology, Queensland Health - Princess Alexandra Hospital, Brisbane, Australia.
实施胃肠科医生领导的质量框架显著减少了结肠镜后结肠直肠癌 (PCCRCs). 这项质量保证计划被证明是具有成本效益的,改善了患者的治疗结果,并减少了癌症发病率.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 减少结肠直肠癌的发病率和死亡率是结肠镜检查的一个关键目标.
- 结肠镜后结肠直肠癌 (PCCRCs) 是结肠镜质量的关键结果指标.
- 结肠镜检查中的质量保证措施可以通过分析PCCRC率来验证.
研究的目的:
- 评估胃肠科医生领导的质量框架在降低PCCRC率方面的有效性.
- 为了比较PCCRC率在实施质量框架之前和之后,监测肠道准备,腺瘤检测和患者满意度.
- 评估实施的质量改善措施的成本效益.
主要方法:
- 一项回顾性队列研究,涉及2010年至2017年期间接受结肠镜检查的19383人.
- 与全州癌症注册和医院记录的数据链接,以在阴性结肠镜检查后5年内识别PCCRC.
- 在基准期 (2010-2014年) 和重新设计阶段 (2015-2017年) 之间的PCCRC率的比较,使用质量框架.
主要成果:
- 总体PCCRC率为每1000人年0.376的人.
- 与质量框架实施期间 (0.027%) 相比,PCCRC率在基准期 (0.166%) 显著高于质量框架实施期间 (0.027%).
- 质量改进过程显示,每个PCCRC的增量成本效益比为-5670.53美元.
结论:
- 一个由胃肠科医生领导的正式质量保证框架有效地减少了间隔结肠直肠癌.
- 实施的质量框架具有成本效益,考虑到获得的生命年数和质量调整的生命年数.
- 将质量保证纳入常规的临床操作中,可以提高结肠镜检查的结果.
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