Main Factors Influencing the Quality of Care for Patients with Biliary Pathology on the Secondary Level

Yu.M. Stepanov, І.Yu. Skirda

Abstract


Our aim was to determine the factors influencing the clinical outcome in inpatient care for the patients with the biliary system diseases. This study demonstrated a relationship between the hospital size and clinical outcome of endoscopic drainage for acute cholangitis. It was found that the stay of patients in high volume hospitals was shorter (26.8 ± 22.6 days in the low volume hospitals against 23.3 ± 21.5 and 19.7 ± 17.2 days in high volume and average volume hospitals, р < 0.001). There were also registered less drainage complications (5.6 % in low volume hospitals against 4.3 % in the secondary hospitals and 3.2 % in high volume hospitals, р < 0.001). Endoscopic drainage of gall, endoscopic retrograde cholangiopancreatography and nasobiliary drainage were found to be useful in biliary decompression. The experience of endoscopists performing effective endoscopic gall drainage, and sufficient resources in high volume hospitals are associated with better clinical outcome of endoscopic surgery for acute cholangitis. The elderly patients with severe comorbidities the risk of complications increased due to those interventions. Endoscopic interventions require highly skilled team that consists of endoscopists and other professionals, including recreation therapists. These professionals typically work in high volume hospitals and can provide interdisciplinary medical care that largely improves clinical outcomes.


Keywords


hospital size; endoscopic gall drainage; acute cholangitis; clinical outcomes

References


Організація контролю якості медичної допомоги в закладах охорони здоров’я: метод. реком. / Н.Г. Гойда, О.З. Децик, А.Б. Зіменковський [та ін.]. — К., 2013. — 42 с.

Лейшнер У. Практическое руководство по заболеваниям желчных путей / У. Лейшнер. — М.: ГЭОТАР-Медиа, 2001. — 264 с.

Линденбратен А.Л. Некоторые организационно-методологические аспекты оценки качества медицинской помощи / А.Л. Линденбратен // Управление качеством медицинской помощи в Российской Федерации. — М., 1997. — С. 63-67.

Мескон М.Х. Основы менеджмента: пер. с англ. / М.Х. Мескон, М. Альберт, Ф. Хедоури. — М.: Дело, 1998. — 799 с.

Степанов Ю.М. Основні показники діяльності медичних установ України, які надають хірургічну допомогу пацієнтам з біліарною патологією на вторинному рівні (за період 2006–2012 рр.) / Ю.М. Степанов, І.Ю. Скирда // Гастроентерологія = Gastroenterology. — 2013. —

№ 4(50). — С. 6-12.

Клименко Г.А. Холедохолитиаз (диагностика и оперативное лечение) / Г.А. Клименко. — М.: Медицина, 2000. — 224 с.

Уханов А.П. Использование видеолапароскопии в лечении острого холецистита / А.П. Уханов, Б.А. Веселовский // Эндоскопическая хирургия. — 2002. — № 3. — С. 78-79.

Щадящая хирургия (избранные главы) / под ред. Ю.Л. Шевченко. — М.: ГЭОТАР-Медиа, 2005. — 320 с.

Randomised trials in surgery: problems and possible solutions / P. McCulloch, I. Taylor, M. Sasako [et al.] // BMJ. — 2002. — Vol. 324. — P. 1448-1451.

Алиев М.А. Лапароскопическая холецистэктомия при калькулезном холецистите у больных с сопутствующими заболеваниями / М.А. Алиев, Д.С. Сексенбаев // Эндоскопическая хирургия. — 1999. — № 4. — С. 24-26.

Бурков С.Г. О последствиях холецистэктомиии постхолецистэктомическом синдроме / С.Г. Бурков // Consilium medicum. — 2004. — Вып. 1. — С. 24-28.

Бойко А.Т. Качество и стандарты медицинской помощи (понятие и принципиальные основы) / А.Т. Бойко [Электронный ресурс]. — Режим доступа: maps.spb.ru/ordinator/addelment/

Шарабчиев Ю.Т. Доступность и качество медицинской помощи: слагаемые успеха / Ю.Т. Шарабчиев, Т.В. Дудина // Медицинские новости. — 2009. — № 12. — С. 6-12.

Agency for Healthcare Researchand Quality AHRQ Quality Indicators (AHRQ QI) Guidanceon Usingthe AHRQ QI for Hospital-Level Comparative Reporting, Version 1.0 (June 30, 2009) [Electronicresource]. — Access mode : http://www.quality indicators.ahrq.gov/Downloads/News/AHRQ_QI_Guide_to_Comparative_Reporting_v10.pdf

The effect of age and procedure on resource use for patients with cerebrovascular disease / K. Kuwabara, S. Matsuda, Y. Imanaka [et al.] // J. Health. Serv. Res. Policy. — 2008. — Vol. 13. — P. 26-32.

Hospital volume outcome relationships among medical admissions to ICUs / L. Durairaj, J. C. Torner, E. A. Chrischilles [et al.] // Chest. — 2005. — Vol. 128. — P. 1682-1689.

Unusual cases of acute cholecystitis and cholangitis: Tokyo guidelines / H. Yasuda, T. Takada, Y. Kawarada [et al.] // J. Hepatobiliary Pancreat. Surg. — 2007. — Vol. 14. — P. 98-113.

Lipsett P.A.A. Acute cholangitis / P.A. Lipsett, H.A. // Pitt. Fron. Biosci. — 2003. — № 8. — P. 1229-1239.

Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines / Y. Kimura, T. Takada, Y. Kawarada [et al.] // J. Hepatobiliary Pancreat. Surg. — 2007. — Vol. 14. — P. 15-26.

Hematopoietic cell transplantation (HCT) — specific comorbidity index: a new tool for risk assessment before allogeneic HCT / M.L. Sorror, M.B. Maris, R. Storb [et al.] // Blood. — 2005. — Vol. 106. — P. 2912-2919.

Freeman M.L. Complications of endoscopic biliary sphincterot — omy: a review / M.L. Freeman // Endoscopy. — 1997. — Vol. 29. — P. 288-2897.

Comparison between endoscopic papillary balloon dilatation and endoscopic sphincterotomy for the treatment of common bile duct stones / H. Watanabe, M. Yoneda, K. Tominaga [et al.] // J. Gastroenterol. — 2007. — Vol. 42. — P. 56-62.

Matsuda S. Casemix as a tool for transparency of medical services / S. Matsuda // Jpn. J. Soc. Secur. Policy. — 2008. — № 6. — P. 43-53.

Development and use of the Japanese case mix system / S. Matsuda, К. Ishikawa, K. Kuwabara [et al.] // Eurohealth. — 2008. — Vol. 14. — P. 25-30.

Lum D.F. Bacterial cholangitis / D.F. Lum, J.W. Leung // Curr. Treat. Options Gastroenterol. — 2001. — № 4. — P. 139-136.

Endoscopic biliary drainage for acute obstructive cholangitis: effects of bilionasal drainage and stent placement / H. Matsunaga, T. Takeda, H. Konomi [et al.] // J. Hepatobiliary Pancreat. Surg. — 1996. — № 3. — P. 27-32.

The safety and effectiveness of endoscopic biliary decompression by plastic stent placement in acute suppurative cholangitis compared with nasobiliary drainage / S.Y. Park, C.H. Park, S.B. Cho [et al.] // Gastrointest. Endosc. — 2008. — Vol. 68. — P. 1076-1080.

Therapeutic ERCP for choledocholithiasis in patients 80 years of age and older / A. Murata, Y. Motomura, K. Akahoshi [et al.] // J. Clin. Gastroenterol. — 2009. — Vol. 43. —

P. 289-290.

Luft H.S. Should operations be regionalized? The empirical relation between surgical volume and mortality / Luft H.S., Bunker J.P., Enthoven A.C. // N. Engl. J. Med. — 1979. —

Vol. 301. — P. 1364-1369.

Urbach D.R. Does it matter what a hospital is «high volume» for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data / D.R. Urbach, N.N. Baxter // BMJ. — 2004. — Vol. 328. — P. 737-740.

Birkmeyer J.D. Should we regionalize major surgery? Potential benefits and policy considerations / J.D. Birkmeyer // J. Am. Coll. Surg. — 2000. — Vol. 190. — P. 341-349.

Hospital volume and surgical mortality in the United States / J.D. Birkmeyer, A.E. Siewers, E.V. Finlayson [et al.] // N. Engl. J. Med. — 2002. — Vol. 346. — P. 1128-1137.

The volume outcomes effect in hepatopancreatobiliary surgery: hospital versus surgeon contributions and specificity of the relationship / H. Nathan, J.L. Cameron, M.A. Choti [et al.] // J. Am. Coll. Surg. — 2009. — Vol. 208. — P. 528-538.

The association between hospital volume and survival after acute myocardial infarction in elderly patients / D.R. Thiemann, J. Coresh, W.J. Oetgen, N.R. Powe // N. Engl. J. Med. — 1999. — Vol. 340. — P. 1640-1648.

Relationship among hospital ERCP volume, length of stay, and technical outcomes / S. Varadarajulu, M.L. Kilgore, C.M. Wilcox, M.A. Eloubeidi // Gastrointest. Endosc. — 2006. — Vol. 64. — P. 338-347.

Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project / C. Kapral, C. Duller, F. Wewalka [et al.] // Endoscopy. — 2008. — Vol. 40. — P. 625-630.

Establishing a true assessment of endoscopic competence in ERCP during training and beyond: a single-operator learning curve for deep biliary cannulation in patients with native papillary anatomy / D. Verma, C.J. Gostout, В.Т. Petersen [et al.] // Gastrointest. Endosc. — 2007 — Vol. 65. — P. 394-400.

Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography / P.S. Jowell, J. Baillie, M.S. Branch [et al.] // Ann. Intern. Med. — 1996. — Vol. 125. — P. 983-989.

Disario J.A. Hospital volume and ERCP outcomes: the writing is on the wall / J.A. Disario // Gastrointest. Endosc. — 2006. — Vol. 64. — P. 348-350.

Petersen В.Т. ERCP outcomes: defining the operators, experience, and environments / В.Т. Petersen // Gastrointest. Endosc. — 2002. — Vol. 55. — P. 953-958.

Techniques of biliary drainage for acute cholangitis: Tokyo guidelines / T. Tsuyuguchi, T. Takada, Y. Kawarada [et al.] // J. Hepatobiliary Pancreat. Surg. — 2007. — Vol. 14. — P. 46-51.

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee. Guidelines for training in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) // Surg. Endosc. — 2007. — Vol. 21. — P. 1010-1011.

A novel and practicable ERCP training system with simulated fluoroscopy / E. Frimberger, von Delius S.,

T. Rosch [et al.] // Endoscopy. — 2008. — Vol. 40. —

P. 517-520.

ERCP training and experience / J.D. Waye, P.C. Bornman, N. Chopita [et al.] // Gastrointest. Endosc. — 2006. — Vol. 56. — P. 607-608.




DOI: https://doi.org/10.22141/2308-2097.2.52.2014.81941

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