质量措施,以提高初级胆管结肠炎的管理和治疗:德尔菲共识研究研究
Domenico Alvaro1, Vincenza Calvaruso2, Marco Carbone3
1Sapienza University of Rome, Rome, Italy.
概括
这项研究开发了初级胆道胆道炎 (PBC) 护理的质量指标,建议进行非侵入性诊断和量身定制的治疗. 基于共识的方法旨在改善这种慢性自身免疫性肝病的患者管理和结果.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 自免疫性疾病 自免疫性疾病
- 改善临床质量 改善临床质量
背景情况:
- 初级胆管胆炎 (PBC) 是一种慢性自身免疫性肝脏疾病,导致胆道破坏,胆质病和纤维化.
- 目前对PBC的管理面临的挑战是诊断标准化,治疗反应评估和以患者为中心的护理.
- 在优化PBC管理方面的差距需要制定基于共识的质量措施.
研究的目的:
- 制定共识驱动的质量措施,以优化初级胆汁胆道炎 (PBC) 的管理.
- 解决诊断方案,治疗反应评估和以患者为中心的PBC患者护理现有的缺口.
主要方法:
- 采用了德尔菲的方法,包括对92名临床医生进行两轮调查.
- 调查涵盖了诊断方案,治疗策略,后续标准和患者报告的结果 (PRO).
- 使用RAND/UCLA方法分析适当性评级,并就质量指标达成共识.
主要成果:
- 强大的共识支持非侵入性工具,如振动控制的暂时弹性图像 (VCTE) 和超声波用于纤维化阶段和监测.
- 早期启动替代疗法是适当的对患者有不充分的反应或不耐受ursodeoxycholic 酸 (UDCA).
- 对遗传研究和肝活检的共识的变化突出显示了未来研究的领域,特别是在没有生物化学胆固醇症的患者中.
结论:
- 已经建立了PBC护理的可操作的质量措施,包括诊断,治疗和随访的建议.
- 这些措施超出了现有的指导方针,通过解决患者分层和后续战略.
- 未来的研究应该侧重于成本效益,获取非侵入性工具,以及临床医师培训等实施挑战.
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