Outcomes research in endoscopy: current status and future directions

Model construction of medical endoscope service evaluation system-based on the analysis of Delphi method

Background

Medical endoscope is widely used in clinical practice for the purpose of diagnosis and treatment, occupying around 5% of the medical device market. Evaluating the true service level of medical endoscope is essential and necessary to improve overall performance of medical diagnosis and treatment, and to maintain competitiveness of endoscope manufacturers, however, such a tool is not available in the market. This study develops an Evaluation Index System (EIS) to assess service level of medical endoscope, and to provide suggestions for improving the service level through the Delphi method.

Methods

Firstly, the possible factors influencing the service level were identified from literature review. In parallel, the Delphi expert method questionnaire was designed and 25 experts were invited to conduct three rounds of questionnaire, to evaluate and rate the possible factors. Finally, we determined the weights associated with the factors, using the analytic hierarchy process (AHP) and percentage method, and developed the service level EIS.

Results

The EIS consists of 3 first-level indicators, 24 s-level indicators and 68 third-level indicators. According to the weights computed using AHP, first-level indicators are ranked as post-sale (0.62), in-sale (0.25) and pre-sale (0.13). Through case verification, the medical endoscope brand Olympus had a total score of 4.17, Shanghai Aohua had a total score of 3.71, and Shanghai Chengyun had a total score of 3.28, which matches its market popularity and ranking in terms of market share. The results obtained from the EIS are consistent with the reality.

Conclusions

The EIS established in this study is comprehensive, reliable and reasonable with strong practicality. The EIS can act as a tool for the endoscope users to evaluate potential products and make informed choices. It also provides a measurable basis for endoscope manufacturers and service providers to improve service quality.

Clinical research

Opportunities for clinical research should be explored carefully. Sites should evaluate potential areas of success, and focus on developing a quality center that can provide accurate data. Although there are numerous challenges to building a successful and productive research center, the rewards are great.

Waiting lines in the endoscopy unit

BACKGROUND

The efficient management of the endoscopy unit involves issues of scheduling. The aim of this study was to assess efficient use of an endoscopy unit and its relationship to patient waiting.

METHODS

Formulas of queueing theory are applied to patient scheduling in endoscopy. The M/M/n queueing model assumes exponential (Markovian) distributions underlying both patient arrival and endoscopy times with n as the number of endoscopists, while the D/M/n model assumes a constant (deterministic) patient arrival rate.

RESULTS

As the use of the facility increases, so does the probability that patients will have to wait. It is impossible for an endoscopy facility to have a 100% rate of use without patients being forced to wait. Any increase in the use rate of an endoscopy unit results in a concomitant increase in waiting times. A facility with multiple endoscopists can reduce waiting probability at a higher rate of facility use. A table is included that physicians and administrators can use as a guide to estimate the use rate and waiting characteristics of different types of endoscopy facilities.

CONCLUSIONS

Endoscopy units must find a balance between patient waiting and underuse of their resources. Endoscopists will occasionally find themselves idle at the benefit of providing patients with tolerable waiting times. It needs to be explained to patients that even under the best of circumstances some waiting cannot be prevented.

Timing and scheduling of endoscopic procedures

BACKGROUND

The aim of the present analysis is to compare the costs associated with different schemes of scheduling tests and to develop recommendations concerning the most cost-effective means for timing individual endoscopic procedures.

METHODS

The diagnostic costs of three competing strategies to schedule various radiologic and endoscopic procedures in patients with jaundice or gastrointestinal hemorrhage are compared by computer models using a Monte Carlo simulation. In strategy 1, the evaluation is started with the most promising procedure and proceeds with the next most promising procedure in case of a normal finding. In strategy 2, physicians adhere to a rigid sequence of diagnostic tests that starts with the least expensive procedure and advances through progressively more expensive procedures. In strategy 3, all promising tests are scheduled at the onset without waiting for test results to decide in favor or against individual procedures. In the Monte Carlo simulation, two hypothetical populations of 5000 inpatients or outpatients are subjected to each strategy.

RESULTS

Unless one particular diagnosis is suspected with a high a priori probability, a rigid sequence of advancing from less to more expensive and invasive procedures provides the cheapest diagnostic strategy. In case of limited access to endoscopy and long waiting times, the cheapest work-up may include simultaneous scheduling of complementary procedures without waiting for intermediate test results. Strategy 1 of starting with the most promising test procedure becomes the least expensive option, if the prior probability assigned to the most likely diagnosis exceeds a threshold between 40% and 70%, depending on the type of test needed to make the diagnosis.

CONCLUSIONS

An expeditious diagnostic evaluation or an evaluation that is guided primarily by medical considerations is more likely to result in low healthcare costs.