QS ENDO Real – A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland

Abstract

Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patientsʼ medical history, some centers (6.6 – 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.

A Comparative Study of Endometriosis and Normal Endometrium Based on Ultrasound Observation

“…There is grayscale processing inside. Grayscale processing refers to the method of changing the gray value of each pixel in the source image point-to-point according to the transformation relationship based on specific target conditions [ 17 , 18 ]. In grayscale, in the RGB model, if R = G = B , the color represents a grayscale color.…”

Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

“…International and national guidelines recommend a histological assessment after surgical procedures to make a diagnosis of endometriosis 5 , 6 . An initiative to evaluate the quality of care in endometriosis centers in German-speaking countries in Europe was recently published 7 . It reported that all certified endometriosis centers took biopsies to confirm endometriosis histologically.…”

“…Nevertheless, the current guidelines give no clear statements about the specific procedures for the histological assessment 5 , 6 . Standardized quality indicators for diagnosis and therapy have not been implemented to date 7 .…”

Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis—a retrospective multicenter observational study

“…For example, Bendifallah et al examined the correlation of surgeon and hospital caseloads of colorectal DE and the prevalence of major complications suggesting a critical optimal cut‐off of at least 20 procedures per center per year as a determining factor of surgical morbidity, 10 which is in line with recommendations for the surgical treatment of advanced ovarian cancer 11 . This has stimulated the ongoing process of establishing and certifying centers of excellence for treatment of extensive DE in Germany, Austria, the Czech Republic, Romania, Hungary and Switzerland primarily initiated by the Stiftung Endometrioseforschung following defined criteria and recommended caseloads for certain degrees of excellence and certification 12 . Hence, the aim of the present study was to evaluate the prevalence of major complications in certified tertiary referral centers for endometriosis and to examine a possible association between hospital caseload and the occurrence of grade III–IV complications following surgery for colorectal DE.…”

“… 11 This has stimulated the ongoing process of establishing and certifying centers of excellence for treatment of extensive DE in Germany, Austria, the Czech Republic, Romania, Hungary and Switzerland primarily initiated by the Stiftung Endometrioseforschung following defined criteria and recommended caseloads for certain degrees of excellence and certification. 12 Hence, the aim of the present study was to evaluate the prevalence of major complications in certified tertiary referral centers for endometriosis and to examine a possible association between hospital caseload and the occurrence of grade III–IV complications following surgery for colorectal DE.…”