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证明了常规诊断 内窥镜检查不能改善急性上部患者的结果 胃肠道出血（UGIB），可用信息表明它 在这种情况下被广泛使用。 内窥镜检查的支持者证明其合理 通过引用几个因素，例如对出血来源的了解， 在临床试验中未解决。 因此，似乎 要么诊断上层内窥镜检查过多地化了 可用临床试验提供的数据不足 明确评估其在这些患者中的适当作用。 目的 这项研究是评估诊断内窥镜检查在成人中的作用 使用分析层次结构过程的简单UGIB的患者 （AHP），一种多标准决策技术。 我们假设上内窥镜被过度利用。 测试 这个假设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。 采访将 获取完成每个人的单个AHP分析所需的信息 约束确定患者护理策略与他们的患者护理策略最一致 对相关数据和判断的解释 5个患者管理目标的重要性，包括了解 出血地点。 然后，我们将比较个人的比例 每个通过AHP分析，将常规内窥镜识别为 首选管理策略，当前的内窥镜检查速率 医院（85％）。 这两个率之间的一个显着差异将 确认我们的假设，并表明初级保健医师和 我们医院的患者不重视有关出血现场的信息 对于大多数患者，足以证明常规内窥镜检查是合理的。 这一发现可能适用于其他诊断测试决策。 不管 结果，这项研究将展示一种评估的新方法 诊断技术并提供有关患者和物理学的信息 CIANS对在急性UGIB中使用诊断测试的态度。