CLINICAL OUTCOMES RESEARCH--AN ENDOSCOPIC DATABASE

提高保健服务质量和降低保健服务成本的压力使人们有必要了解诸如胃肠内窥镜检查等医疗干预措施的有效性。尽管内窥镜手术被广泛使用，但人们对内窥镜手术模式和患者在社区环境中的预后知之甚少。研究内窥镜检查程序的理想方法是直接找到源头：内窥镜检查报告。随着计算机化数据库的出现，现在可以在创建数据文件的同时生成内窥镜报告。我们在不同的实践环境中建立了一个GI专家网络，他们使用通用的计算机内窥镜报告生成器。来自这些临床附属机构的内窥镜数据以电子方式传输到一个集中的数据存储库，并与来自多个临床附属机构的数据合并进行分析。这些合并的数据可以用来检查实践模式和解决重要的研究问题。基于在建立内窥镜研究临床网络方面的丰富经验，我们的团队是独一无二的，能够满足当前提案中规定的要求。本提案的主要目标是利用现有的内窥镜数据库获取信息，以提高胃肠病学临床实践的质量。本建议的具体目的是利用内窥镜数据库：对内窥镜检查结果的使用、频率和严重程度、实践模式、实践变化（地理区域、临床实践类型）和患者人口统计（年龄、性别、种族）进行描述性分析。使用描述性分析形成发展假设和风险分层的基础。观察慢性胃肠道疾病的自然病史，确定适当的监测间隔。确定内镜治疗和新的内镜创新的成功和有效性。确定内镜诊断和治疗对患者预后的影响。评估内窥镜并发症的频率和并发症的危险因素。将数据库用于特定的研究项目，并为临床试验创建患者注册表。

Pressure to improve quality and lower cost of health cre has created the need to understand the effectiveness of medical interventions, such as gastrointestinal (GI) endoscopy. Despite widespread use of endoscopic procedures, very little is known about endoscopic practice patterns and patient outcomes in community-based settings. The ideal method for studying endoscopic procedures is to go directly to the source: the endoscopy report. With the advent of computerized databases, it is now possible to generate endoscopic reports while simultaneously creating a data file. We have developed a network of GI specialists in diverse practice settings who utilize a common computerized endoscopic report generator. Endoscopic data from these Clinical Affiliates is transmitted electronically to a centralized data repository and merged with data from multiple Clinical Affiliates for analysis. These merged data can then be used to examine practice patterns and address important research questions. Based on extensive experience in building a clinical network for endoscopic research our group is unique able to meet the requirements stipulated in the current proposal. The primary goal of this proposal is to use the existing endoscopic database to acquire information that will improve the quality of clinical practice in gastroenterology. The specific aims of this proposal are to use the endoscopic database to: . Perform descriptive analyses of utilization, frequency and severity of endoscopic findings, practice patterns, practice variation (geographic region, type of clinical practice), and patient demographics (age, gender, race). . Use descriptive analyses to form the basis for developing hypotheses and risk stratification. . Observe the natural history of chronic GI diseases, and determine appropriate intervals for surveillance. . Determine the success and effectiveness of endoscopic therapies and new endoscopic innovations. . Determine the impact of endoscopic diagnoses and therapies on patient outcomes. . Evaluate the frequency of endoscopic complications, and risk factors for complications. . Use the database for specific research projects and to create patient registries for clinical trials.