THE ROLE OF ENDOSCOPY IN UPPER GASTROINTESTINAL BLEEDING

内窥镜检查在上消化道出血中的作用

• 批准号: 3372001
• 负责人: James G Dolan
• 金额: $ 7.15万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-02-01 至 1992-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3372001
• 关键词: adult human (21+); computer assisted medical decision making; diagnosis design /evaluation; diagnosis quality /standard; disease /disorder proneness /risk; gastrointestinal hemorrhage; gastroscopy; health care service utilization; human subject; interview; patient care planning; primary care physician

Despite evidence from controlled trials that routine diagnostic endoscopy does not improve the outcome of patients with acute upper gastrointestinal bleeding (UGIB), available information suggests that it is widely used in this situation. Proponents of endoscopy justify its use by citing several factors, such as knowledge of the bleeding source, that were not addressed in the clinical trials. It seems, therefore, that either diagnostic upper endoscopy is being overutilized or that the data provided by the available clinical trials are inadequate to definitively assess its proper role in these patients. The purpose of this study is to assess the role of diagnostic endoscopy in adult patients with uncomplicated UGIB using the analytic hierarchy process (AHP), a multicriteria decision making technique. We hypothesize that upper endoscopy is being overutilized. To test this hypothesis we will interview primary care physicians and patients who have recently had an uncomplicated acute UGIB. The interviews will elicit information needed to complete individual AHP analyses for each subject to determine the patient care strategy most consistent with their interpretations of the relevant data and judgements regarding the rela- tive importance of 5 patient management goals, including knowledge of the bleeding site. We will then compare the proportion of individuals in each group who, through AHP analysis, identify routine endoscopy as the preferred management strategy with the current rate of endoscopy at our hospital (85%). A significant difference between these 2 rates would confirm our hypothesis and indicate that primary care physicians and patients at our hospital do not value information about the bleeding site highly enough to justify routine endoscopy for most of these patients. This finding may apply to other diagnostic testing decisions. Regardless of the outcome, this study will demonstrate a new method for assessing diagnostic technology and provide information about patients' and physi- cians' attitudes regarding the use of diagnostic testing in acute UGIB.

尽管对照试验的证据表明，常规诊断 内镜检查并不能改善急性上消化道疾病患者的预后， 消化道出血（UGIB），现有信息表明， 在这种情况下被广泛使用。 内窥镜检查的支持者证明其 通过引用几个因素来使用，例如对出血源的了解， 临床试验中没有涉及到的问题。 因此， 诊断性上消化道内窥镜检查被过度使用， 现有临床试验提供的数据不足以 明确评估其在这些患者中的适当作用。 的目的 本研究旨在评估诊断性内窥镜检查在成人中的作用， 使用层次分析法对无并发症的UGIB患者进行分析 (AHP)多准则决策技术。 我们假设上消化道内镜检查被过度使用。 测试 我们将采访初级保健医生和患者 最近有一个简单的急性UGIB。 面试将 获取所需的信息，以完成每个层次分析法分析 受试者确定最符合其 有关数据的解释和有关关系的判断， 5个患者管理目标的重要性，包括 出血部位。 然后我们将比较 每组通过AHP分析，确定常规内镜为 首选的管理策略与目前的内镜检查率在我们的 医院（85%） 这两个比率之间的显著差异将 证实了我们的假设，并指出，初级保健医生和 我们医院的患者不重视出血部位的信息 足以证明大多数患者的常规内窥镜检查是正确的。 这一发现可能适用于其他诊断测试决策。 无论 这项研究将展示一种新的评估方法， 诊断技术，并提供有关病人的信息和物理， 医生对急性UGIB诊断检测的态度。