Transforming Endometriosis Management: Insights from a Six-Year Application of the 4P Approach

Transforming Endometriosis Management: Insights from a Six-Year Application of the 4P Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transforming Endometriosis Management: Insights from a Six-Year Application of the 4P Approach Shunhe Lin, Wei Qi, Jinna Zhang, Chaobin Liu, Xi Xie, Zhenna Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5013696/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To systematically evaluate the effectiveness of the 4P management model (Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement) in the specialty management of endometriosis, and to explore its impact on disease management effectiveness. Methods A retrospective analysis was conducted using data collected from January 2018 to December 2023, encompassing outpatient and inpatient workload statistics, as well as patient satisfaction surveys. A total of 636 patients who attended the endometriosis specialty clinic between January 2020 and December 2021 were selected as the observation group, while 613 patients from the same period served as the control group. The observation group received standard care integrated with the 4P management approach. In contrast, the control group was treated with traditional standard care alone. Key study indicators included patient follow-up adherence, quality of life assessments, and evaluations of negative emotional status. Results The observation group demonstrated notable enhancements in follow-up adherence, a significant reduction in visual analogue scale/scores (VAS) for pain, and a marked decrease in negative emotional disturbances. Additionally, clinical workload, both outpatient and inpatient, saw considerable growth, with outpatient visits increasing from 574 cases to 2,546 cases and inpatient admissions rising from 432 cases to 997 cases. Patient satisfaction also improved substantially, with outpatient satisfaction rates climbing from 93.2–97.8% and inpatient satisfaction rates growing from 91.8–98.6%. Conclusion The implementation of the 4P management model significantly enhanced patient follow-up adherence, improved quality of life and patient satisfaction, and reduced negative emotional disturbances. This comprehensive approach to managing endometriosis highlights its substantial potential in optimizing specialized care, ensuring consistent and high-quality outcomes. The 4P model offers valuable insights and practical strategies for healthcare institutions seeking to implement innovative and patient-centered management practices in the treatment of endometriosis. Endometriosis Specialty Management 4P Management Approach Follow-up Adherence Quality of Life (QoL) Figures Figure 1 Figure 2 Introduction Endometriosis is a chronic gynecological disorder that significantly impacts the health and quality of life of women of reproductive age. It is characterized by the presence of endometrial-like tissue outside the uterus, which can lead to symptoms such as dysmenorrhea, chronic pelvic pain, and infertility [ 1 ]. These clinical manifestations not only cause physical discomfort but also have profound psychological and social consequences, including emotional distress, anxiety, depression, and reduced social functioning [ 2 ]. Managing endometriosis is challenging due to the heterogeneity of symptoms and the complexity of the disease, which often requires long-term and multifaceted treatment strategies [ 3 ]. Traditional diagnostic and therapeutic approaches for endometriosis, which primarily rely on hormonal treatments and surgical interventions, often fail to meet the comprehensive needs of patients [ 4 ]. These methods tend to focus on symptom relief rather than holistic patient care, leading to inconsistent treatment outcomes and frequent recurrence of symptoms. Furthermore, the lack of specialized and coordinated care models results in variability in treatment quality, potentially compromising patient outcomes and satisfaction. Recognizing these challenges, there has been growing interest in developing specialized management models for endometriosis that prioritize comprehensive and consistent care [ 5 – 8 ]. Key strategies include establishing dedicated multidisciplinary medical teams, optimizing diagnostic and therapeutic protocols, and enhancing patient management practices [ 9 , 10 ]. These efforts aim to improve overall treatment outcomes by providing tailored, high-quality care. However, traditional management approaches often fall short due to a lack of coordinated care and individualized treatment plans, failing to adequately address the varied and complex manifestations of endometriosis, which leads to less than optimal patient outcomes [ 11 ]. In response to the limitations of conventional care models, Fujian Maternity and Child Health Hospital has implemented an innovative 4P management model designed to enhance treatment outcomes through systematic and patient-centered care. The 4P model stands for Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement. This approach emphasizes building specialized healthcare teams and implementing targeted training to ensure consistent, high-quality care. It also involves customizing treatment plans based on individual clinical profiles, thereby avoiding a one-size-fits-all approach. By integrating various medical disciplines such as endocrinology, pain management, and psychology, the model offers comprehensive, multidisciplinary care. Additionally, it encourages active participation from patients and their families, promoting adherence to treatment protocols and fostering a sense of responsibility in managing the disease. This holistic and innovative approach not only addresses the physical and psychological aspects of endometriosis but also aims to improve overall patient satisfaction and quality of life. This study systematically evaluates the effectiveness of the 4P management model over the past six years at Fujian Maternity and Child Health Hospital. By examining critical outcomes such as follow-up adherence, quality of life, emotional well-being, clinical workload, and patient satisfaction, this research provides valuable insights into the impact of the 4P model in enhancing endometriosis care. The results from this study aim to establish a framework for other healthcare institutions interested in adopting similar specialized management approaches, potentially setting a new benchmark for endometriosis treatment and patient care standards. Methods This study utilized a retrospective analysis of clinical and quality control data from endometriosis patients treated at a tertiary care hospital over the past six years. Data were extracted from the hospital's electronic medical records and patient follow-up databases. Key outcome measures included patient follow-up adherence, quality of life, emotional well-being, specialty clinic workload, and patient satisfaction. These indicators were selected to provide a comprehensive assessment of the effectiveness of the management strategies implemented. Study Subjects The study included a clinical observation component, selecting 636 patients who attended the endometriosis specialty clinic between January 2020 and December 2021 were selected as the observation group, while 613 patients from the same period served as the control group. Inclusion criteria were: 1) patients who underwent surgical treatment for endometriosis at the hospital; 2) patients who participated in follow-up visits every 3–6 months; 3) patients who voluntarily agreed to participate in the study. Exclusion criteria were: 1) patients with severe complications or concurrent internal or surgical diseases; 2) patients unable to commit to long-term follow-up; 3) patients unwilling to participate. This study received approval from the hospital’s ethics committee (Ethics Approval Number: 2018-087), and all participants signed informed consent forms. Study Approach The observation group received a novel 4P management model, which was specifically designed to address the multifaceted needs of endometriosis patients. This model, encompassing Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement, aims to provide a holistic, systematic, and patient-centered approach to treatment. These elements enhance care quality and ensure consistency in endometriosis management. To implement the 4P approach, specialized teams were formed, treatment plans were tailored to individual patient needs, multidisciplinary collaboration was emphasized, and active patient and family engagement was encouraged. Table 1 outlines the key activities, goals, and expected outcomes associated with each component of the 4P management model. Table 1 Overview of the 4P Management Model for Endometriosis Care 4P Management Model Key Activities Goals Expected Outcomes Professionalized Management - Form specialized endometriosis teams - Provide targeted training - International collaboration and learning - Ensure consistent and high-quality care - Standardize treatment protocols - Improved treatment consistency - Reduced unnecessary surgeries Personalized Management - Tailor treatment plans to individual needs - Weekly research and training sessions - Avoid one-size-fits-all approach - Enhance patient satisfaction - Better treatment outcomes - Increased patient satisfaction Pluralistic Management - Multidisciplinary collaboration - Combine pharmacological and surgical interventions - Regular multidisciplinary meetings - Provide comprehensive care - Address mental health and prevention - Comprehensive treatment plans - Improved mental health outcomes Participatory Management - Establish holistic care team - Organize patient education sessions - Maintain patient database - Increase patient engagement - Enhance self-management capabilities - Improved follow-up adherence - Higher patient satisfaction Note: Table 1 summarizes the key components, activities, goals, and expected outcomes of the 4P management model for endometriosis care. The model includes Professionalized Management for high-quality care through specialized teams; Personalized Management to tailor treatment to individual needs; Pluralistic Management to incorporate multidisciplinary collaboration; and Participatory Management to enhance patient engagement. Data Collection Follow-up Adherence Follow-up adherence was categorized into three distinct groups: complete adherence, partial adherence, and non-adherence. Complete adherence was defined as patients who attended all scheduled follow-up visits according to the prescribed timeline. Partial adherence referred to patients who occasionally missed some follow-up visits but generally participated in the majority of them. Non-adherence was defined as patients who did not participate in any follow-up visits.The chi-square (χ²) test was employed to compare the adherence rates between the observation group and the control group. Quality of Life The VAS was utilized to assess the improvement in patients' pain symptoms over time. VAS is a widely recognized tool that measures pain intensity on a scale, where patients indicated their pain levels at 2, 4, and 6 months following surgery. By analyzing and comparing VAS scores across these different time points, we identified trends in pain reduction, providing insight into the effectiveness of the 4P management model in enhancing the quality of life for patients with endometriosis. Negative Emotional Disturbances Changes in patients' negative emotional states were assessed using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). The SAS measured levels of anxiety, while the SDS evaluated levels of depression. By comparing SAS and SDS scores from before surgery to those taken 6 months post-surgery, we analyzed improvements in negative emotional disturbances. Specialty Clinical Workload The changes in the volume of specialty outpatient visits and inpatient admissions were analyzed to evaluate the trend in clinical workload. By comparing the annual growth rates in outpatient visits and inpatient admissions from 2018 to 2023, we assessed the impact of specialty management on clinical workload, highlighting shifts in the burden of work and resource demand associated with the specialty management program. Patient Satisfaction Patient satisfaction data were collected using survey questionnaires completed by both outpatient and inpatient participants. The questionnaires assessed various aspects of care, including the quality of medical services, nursing care, and communication effectiveness. By comparing satisfaction levels over different years, we aimed to evaluate improvements in patient experience associated with the specialized management approach. Data Analysis Data were analyzed using SPSS 26.0 software. Descriptive statistics, including mean, standard deviation, median, and percentages, were used to summarize the data. Independent sample t-tests or Mann-Whitney U tests were conducted to compare differences between various time points or groups, depending on data distribution and type. A significance level of P < 0.05 was set for all tests, and all statistical tests were two-tailed. Results Improvement in Follow-up Adherence Among Endometriosis Patients The follow-up adherence rate was significantly higher in the observation group than in the control group. Complete follow-up adherence was observed in 68.9% of the observation group versus 53.8% in the control group. The χ² test indicated a significant improvement in adherence for the observation group (χ² = 54.26, P < 0.001). Detailed results are shown in Table 2 . Table 2 Comparison of Follow-up Adherence Between Two Groups (n, %) Group Complete Adherence Partial Adherence No Adherence χ2 Value P Value Observation (n = 636) Control (n = 613) 438 330 179 206 19 77 54.26 < 0.001 Note: Complete adherence refers to attending all scheduled follow-up visits; partial adherence indicates attending the majority but missing some; no adherence means not attending any follow-up visits. Statistical significance was assessed using the χ² test, with P < 0.05 indicating significance. Improvement in Quality of Life Among Endometriosis Patients Patients in the observation group experienced significant pain reduction, with notable decreases in chronic pelvic pain. VAS scores decreased progressively at 2, 4, and 6 months post-surgery, indicating enhanced quality of life in the observation group compared to the control group. Detailed VAS score comparisons are presented in Table 3 . Table 3 Comparison of VAS Scores Between the Two Groups ( Mean ± SD ) Group Baseline (Preoperative) 2 Months Postoperative 4 Months Postoperative 6 Months Postoperative P value Observation (n = 636) Control (n = 613) 6.76 ± 1.53 6.81 ± 1.65 4.71 ± 1.32 4.89 ± 1.51 3.27 ± 1.23 4.87 ± 1.04 2.71 ± 0.65 3.83 ± 0.68 < 0.001 < 0.001 P value 0.384 0.067 < 0.001 < 0.001 Note: VAS scores were used to measure the intensity of pain, with lower scores indicating less pain. The progressive decrease in VAS scores at each postoperative time point demonstrated a significant reduction in pain symptoms for patients in the observation group compared to those in the control group. Statistical significance was assessed using independent t-tests, with P < 0.05 considered significant. Improvement in Negative Emotional Disturbances in Endometriosis Patients Endometriosis patients showed significant improvements in negative emotional disturbances, with steady declines observed in both the SAS and SDS scores over the six months following surgery. The observation group experienced more pronounced improvements compared to the control group at the six-month postoperative mark. The differences between the two groups were statistically significant ( P < 0.001), as shown in Table 4 . Table 4 Comparison of Negative Emotional Disturbance Scores Between the Two Groups (Mean ± SD) Group SAS SDS P value Baseline (Preoperative) 2 Months Postoperative 4 Months Postoperative 6 Months Postoperative Observation (n = 636) Control (n = 613) 56.64 ± 5.21 57.35 ± 5.53 36.42 ± 4.33 40.45 ± 5.25 61.92 ± 5.71 60.47 ± 6.04 32.36 ± 4.69 53.47 ± 4.55 < 0.001 < 0.001 P value 0.487 < 0.001 0.656 < 0.001 Note: SAS and SDS scores are used to measure anxiety and depression levels, respectively. Lower scores indicate reduced anxiety and depression symptoms. Statistical significance was determined using appropriate tests, with P < 0.05 considered significant. Steady Increase in Specialized Endometriosis Clinic and Hospitalization Workload The workload of the specialized endometriosis clinic has shown a consistent upward trend over the past six years. Outpatient visits increased significantly, from 574 cases in 2018 to 2,546 cases in 2023. In parallel, the number of hospitalizations also rose, from 432 cases in 2018 to 997 cases in 2023, demonstrating the growing demand for specialized care. These trends are visually represented in Fig. 1 . Gradual Increase in Patient Satisfaction for Endometriosis Care Following the establishment of the specialized endometriosis management program, the standards of care have remained high, with no adverse medical events or patient complaints reported within this specialty. Outpatient satisfaction rates rose from 93.2% in 2018 to 97.8% in 2023. Similarly, inpatient satisfaction rates increased from 91.8% in 2018 to 98.6% in 2023, demonstrating a consistent improvement in patient perceptions of care quality. These trends are illustrated in Fig. 2 . Discussion Current Status and Impact of Endometriosis Specialty Care in China Endometriosis is a multifaceted gynecological disorder that profoundly impacts the health and quality of life of women. In response to the escalating demand for specialized care, leading medical institutions have established dedicated endometriosis clinics and specialty centers [ 12 ]. These centers employ cutting-edge diagnostic technologies, such as high-resolution laparoscopy and magnetic resonance imaging (MRI), to enhance diagnostic precision and facilitate personalized therapeutic strategies [ 13 , 14 ]. Within these specialized settings, laparoscopic surgery has become a standard practice, significantly optimizing the efficiency and outcomes of endometriosis management [ 15 ]. Additionally, substantial advancements have been made in pharmacological therapies, including the use of gonadotropin-releasing hormone (GnRH) agonists [ 16 ] and the novel progestin dienogest [ 17 ]. These pharmacological interventions are effective in controlling symptoms and mitigating recurrence risks, thereby supporting long-term management and enhancing patients' overall quality of life. Despite these advancements, significant challenges persist in the specialized care of endometriosis in China [ 18 – 20 ]. Access to specialized care is predominantly concentrated in top-tier hospitals located in major urban centers, creating barriers for patients residing in smaller cities and rural areas. This uneven distribution of healthcare resources often results in delays in diagnosis and treatment, which can adversely impact overall patient outcomes. Moreover, while sophisticated diagnostic and surgical techniques are available, there is an evident need for more comprehensive care models that holistically address both the physical and psychological dimensions of the disease. To bridge these gaps, innovative approaches to endometriosis management are imperative [ 21 – 24 ]. The findings of this study indicate that the 4P management model, which encompasses Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement, could provide a robust framework for enhancing endometriosis care. By systematically addressing the multifaceted and heterogeneous needs of endometriosis patients, the 4P model has the potential to refine care delivery, amplify treatment efficacy, and foster a more holistic and integrative approach to patient care. Innovative Aspects and Effectiveness of the 4P Management Model The 4P management model, which integrates Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement, represents a substantial advancement in the holistic management of endometriosis. This study has demonstrated that this multifaceted approach effectively meets the complex needs of endometriosis patients, leading to significant improvements in clinical outcomes, patient satisfaction, and overall quality of care. Professionalized Management Professionalized Management focuses on establishing specialized endometriosis care teams, delivering targeted training, and developing standardized treatment protocols [ 25 ]. This structured methodology ensures consistent and high-quality care, effectively addressing the variability commonly observed in conventional care models where patients are required to navigate multiple healthcare providers. Our study revealed a significant increase in follow-up adherence, with rates 15% higher in the observation group than in the control group, demonstrating that professionalized care substantially enhances patient compliance and continuity of care. Furthermore, targeted training and international collaboration have facilitated the adoption of advanced diagnostic and surgical techniques, such as high-resolution laparoscopy. These advancements improve diagnostic precision and therapeutic outcomes, increase treatment consistency, and minimize unnecessary interventions. Personalized Care The personalized care aspect of the 4P model adapts treatment plans to the unique clinical profiles and specific needs of each patient [ 26 , 27 ]. This individualized approach circumvents the limitations of a "one-size-fits-all" methodology, which may result in either overtreatment or insufficient care. Our study demonstrated that patients in the observation group showed a marked reduction in pain, as indicated by the continuous decline in VAS scores over the six-month postoperative period. Personalizing treatment not only effectively alleviates physical symptoms but also significantly enhances patient satisfaction by aligning care with individual expectations and health conditions. Through tailored interventions, this model reduces unnecessary surgical procedures, lowers the risk of complications, and improves overall patient outcomes, establishing a new standard for patient-centered care in endometriosis management. Pluralistic Strategies The pluralistic strategies component of the 4P management model integrates multiple therapeutic modalities and encourages multidisciplinary collaboration [ 28 ]. This comprehensive care framework includes non-invasive imaging techniques, such as MRI and ultrasound, for precise disease assessment, combined with tailored medical and surgical interventions to meet patient needs. Our study showed significant improvements in managing both the physical and psychological symptoms of endometriosis, as evidenced by marked reductions in anxiety and depression scores among patients. Incorporating specialists in endocrinology, pain management, and psychology into the care team ensures a holistic approach, addressing not only the physiological aspects of the disease but also its emotional and psychological impacts [ 29 , 30 ]. This multidisciplinary collaboration is essential for managing complex cases of deep infiltrating endometriosis and optimizing long-term management strategies, including the use of hormonal therapies like GnRH agonists and progestins (e.g., dienogest), which have proven effective in symptom control and preventing recurrence [ 31 – 33 ]. Participatory Involvement The participatory involvement aspect of the 4P model empowers patients by actively engaging them and their families in the care process [ 34 ]. This active participation fosters a sense of responsibility and partnership in disease management, leading to improved treatment adherence and patient satisfaction. Our study found that patient satisfaction rates improved significantly, with outpatient satisfaction reaching 97.8% and inpatient satisfaction at 98.6%. Patient education initiatives, such as workshops and support groups, along with digital tools for health monitoring, play a crucial role in enhancing patient awareness and self-management capabilities. This engagement not only improves clinical outcomes but also enhances the overall healthcare experience, promoting a positive relationship between patients and healthcare providers [ 35 ]. Addressing Challenges Despite the evident success of the 4P management model in enhancing endometriosis care, there are still challenges in scaling this approach across diverse healthcare settings, especially in less resource-rich environments. Expanding access to specialized endometriosis care beyond major urban centers is essential to ensure equitable healthcare delivery. Future efforts should prioritize training healthcare professionals in regional and rural areas, implementing telemedicine for remote consultations, and developing standardized protocols to facilitate the broader adoption of the 4P model. Additionally, continuous research is needed to further refine the model, assess its applicability to other chronic gynecological conditions, and validate its long-term effectiveness. Incorporating patient feedback into care strategies will also be critical for enhancing the model's adaptability and ensuring it meets the evolving needs of patients. Future Directions Building on the insights gained from this study, future research should prioritize conducting randomized controlled trials to establish causality and further validate the effectiveness of the 4P management model. Expanding the implementation of the 4P approach in various healthcare settings, including community hospitals and clinics in rural areas, is essential to ensure broader accessibility and equity in endometriosis care. Investigating the integration of digital health tools, such as mobile apps for patient monitoring and remote consultations, could significantly enhance the scalability and effectiveness of the 4P model. Additionally, international collaboration and knowledge exchange can facilitate the adaptation of the 4P model to meet global standards and practices in endometriosis management. Study Strengths and Limitations This study presents several strengths that contribute to the reliability and robustness of its findings. The large sample size and extended six-year follow-up period provide comprehensive data, enhancing the generalizability of the results. The inclusion of various outcome measures—such as clinical effectiveness, emotional well-being, and quality of life—allows for a holistic assessment of the 4P management model’s impact. Moreover, the successful integration of multidisciplinary care and patient engagement strategies underscores the potential of the 4P model to address both the physical and psychological aspects of endometriosis, establishing a new standard for patient-centered care. However, the study has certain limitations. It was conducted in a single tertiary hospital, which may limit the generalizability of the findings to other healthcare settings, especially those with fewer resources. The observational nature of the study does not allow for definitive causal inferences, as there may be unmeasured confounding variables. Furthermore, the absence of a randomized controlled trial limits the ability to attribute improvements solely to the 4P intervention. Additionally, patient self-reported outcomes, such as satisfaction and emotional well-being, may be subject to bias, potentially affecting the accuracy of these measures. Conclusion The innovative 4P management model presents a transformative approach to endometriosis care, effectively addressing the clinical, emotional, and social dimensions of the disease. By incorporating specialized teams, personalized care plans, multidisciplinary collaboration, and active patient engagement, this model provides a comprehensive solution that not only improves treatment outcomes but also significantly enhances the quality of life for patients. The positive results observed in this study underscore the potential of the 4P model to set a new standard for endometriosis management, offering a scalable framework that can inspire similar approaches in other areas of healthcare. Declarations Acknowledgements The authors would like to acknowledge the participants of the study. Author contributions Shunhe Lin and Wei Qi conceived of this research. Wei Qi conducted data analysis and drafted the article. Shunhe Lin contributed to the draft and revise the article. Shunhe Lin conducted data compilation and data analysis. Chaobin Liu collected medical histories and surgical procedures. Jinna Zhang and Wei Qi were responsible for follow-up and collecting pregnancy-related information. Yuyan Guo, Zhenna Wang and Xi Xie conducted the organization and implementation of the project and final approval of the version to be published as the corresponding author. All authors approved the manuscript and this submission. Funding This work was sponsored by grants from the Fujian Provincial Natural Science Foundation ( No. 2021J01414 and No. 2021J01421 ) and Fujian provincial health technology project ( No. 2022GGB004 ) of China. Data availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate The study protocol was approved by the Research Ethics Committee of Fujian Maternal and Child Health Hospital (grant number 2021-KRD022). Informed consent was obtained from all resident participants in this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363–71. 10.1503/cmaj.220637 . Signorile PG, Viceconte R, Baldi A. New Insights in Pathogenesis of Endometriosis. Front Med (Lausanne). 2022;9:879015. 10.3389/fmed.2022.879015 . Vallvé-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis. Hum Reprod Update. 2019;25(5):564–91. 10.1093/humupd/dmz018 . Mori L, Zaia V, Montagna E, et al. Endometriosis in infertile women: an observational and comparative study of quality of life, anxiety, and depression. BMC Womens Health. 2024;24(1):251. 10.1186/s12905-024-03080-5 . Schreurs AMF, Hoefen WM, Dancet EAF, et al. Towards more patient-centred endometriosis care: a cross-sectional survey using the ENDOCARE questionnaire. Hum Reprod Open. 2020;2020(3):hoaa029. 10.1093/hropen/hoaa029 . Liang Y, Wu J, Wang W, et al. Pro-endometriotic niche in endometriosis. Reprod Biomed Online. 2019;38(4):549–59. 10.1016/j.rbmo.2018.12.025 . Alonso Anais,Gunther Kate,Maheux-Lacroix Sarah,et al.Medical management of endometriosis.CURRENT OPINION IN OBSTETRICS & GYNECOLOGY.2024;36 (5): 353–61. 10.1097/GCO.0000000000000983 Libretti A, Dealberti D, Prigione S, Remorgida V. It's never endometriosis, except when it's endometriosis. Acta Biomed. 2023;94(1):e2023010. 10.23750/abm.v94i1.13701 . Osada Marine F, Emilie L, Lise, et al. Interest of multidisciplinary consultation meetings dedicated to endometriosis: From a series of 682 patients. Gynecologie Obstetrique Fertil Senologie. 2024;52(5):336–42. 10.1016/j. gofs.2024.01.005. Mueller Carolin LR, Miguel S, Lukas, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES. Multidisciplinary surgical management of severe posterior compartment endometriosis. 2024;38 (8): 4677–9. 10.1007/s00464-024-10969-7 Khashchenko EP, Uvarova EV, Fatkhudinov TK, et al. Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features. J Clin Med. 2023;12(4):1678. 10.3390/jcm12041678 . Burghaus Stefanie H, Thomas F, Christine, et al. Standards Used by a Clinical and Scientific Endometriosis Center for the Diagnosis and Therapy of Patients with Endometriosis. Geburtshilfe Frauenheilkd. 2019;79(5):487–97. 10.1055/a-0813-4411 . Rousset Pascal F, Marie B, Nishat, et al. Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging. 2023;104(3):95–112. 10.1016/j.diii . 2022.09.004. Wei DL-FL, Li-Yuan S et al. The Effect of Perioperative Comprehensive Nursing on Patients Undergoing Ovary Endometriosis Laparoscopic Surgery. ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE. 2024.doi:null. Tucker DR, Noga HL, Lee C, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. Pelvic pain comorbidities associated with quality of life after endometriosis surgery. 2023;229 (2): 147.e1-147.e20. 10.1016/j.ajog.2023.04.040 Whitaker LHR, Saraswat L, Horne AW. Combination GnRH antagonists for endometriosis: Balancing efficacy with side effects. Cell Rep Med. 2022;3(9):100748. 10.1016/j.xcrm.2022.100748 . Saglik GB, Topbas SNF, Aydın A et al. Effects of Dienogest Therapy on Endometriosis-Related Dysmenorrhea, Dyspareunia, and Endometrioma Size.Curēus. 2023;15 (1): e34162. 10.7759/cureus.34162 Feng J, Zhang S, Chen J et al. Long-term trends in the incidence of endometriosis in China from 1990 to 2019: a joinpoint and age-period-cohort analysis. GYNECOLOGICAL ENDOCRINOLOGY. 2021;37 (11): 1041–1045. doi: 10.1080/ 09513590. 2021. 1975675. Wang Y, Wang X, Liao K et al. The burden of endometriosis in China from 1990 to 2019. Frontiers in endocrinology. 2022;13: 935931. 10.3389/fendo . 2022. 935931. Danni Z, Zehong Z. Li Rong, Consultation and treatment behaviour of infertile couples in China: a population-based study.REPRODUCTIVE BIOMEDICINE ONLINE. 2019;38 (6): 917–25. 10.1016/j.rbmo.2018.11.034 When more is not better. 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod open. 2019;2019(3):hoz009. 10.1093/hropen/hoz009 . Kodaman Pinar H, OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA. Current strategies for endometriosis management. 2015;42 (1): 87–101. 10.1016/j.ogc.2014.10.005 Vercellini Paolo D, Agnese O, Federica et al. A stepped-care approach to symptomatic endometriosis management: a participatory research initiative. FERTILITY AND STERILITY. 2018; 109 (6): 1086–1096. 10.1016/j. fertnstert. 2018. 01. 037. Buggio Laura B, Giussy F, Federica, et al. Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care. Int J women's health. 2017;9:281–93. 10.2147/IJWH.S119724 . Reid BO, Næss-Pleym LE, Bakkelund KE, et al. A cross-sectional study of mental health-, posttraumatic stress symptoms and post exposure changes in Norwegian ambulance personnel. Scand J Trauma Resusc Emerg Med. 2022;30(1):3. 10.1186/s13049-021-00991-2 . Julian C, Pal N, Gershon A, et al. Overall survival in patients with advanced non-small cell lung cancer with KRAS G12C mutation with or without STK11 and/or KEAP1 mutations in a real-world setting. BMC Cancer. 2023;23(1):352. 10.1186/s12885-023-10778-6 . Omtvedt M, Bean E, Hald K, et al. Patients' and relatives' perspectives on best possible care in the context of developing a multidisciplinary center for endometriosis and adenomyosis: findings from a national survey. BMC Womens Health. 2022;22(1):219. 10.1186/s12905-022-01798-8 . Lega F, Rotolo A, Sartirana M. Dealing with pluralism: the managerial work of CEOs in Italian public healthcare organizations. BMC Health Serv Res. 2022;22(1):1222. 10.1186/s12913-022-08567-1 . Li N, Yuan M, Li Q, et al. Higher Risk of Anxiety and Depression in Women with Adenomyosis as Compared with Those with Uterine Leiomyoma. J Clin Med. 2022;11(9):2638. 10.3390/jcm11092638 . Thiel PS, Bougie Olga P, Jessica, JOURNAL OF OBSTETRICS AND GYNECOLOGY. Endometriosis and mental health: a population-based cohort study.AMERICAN. 2024;230 (6): 649.e1-649.e19. 10.1016/j.ajog.2024.01.023 Carbone MG, Campo G, Papaleo E, et al. The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J Clin Med. 2021;10(8):1616. 10.3390/ jcm10081616. Ugwumadu Lilian C, Rima W-B, Elaine, et al. The role of the multidisciplinary team in the management of deep infiltrating endometriosis. Gynecol Surg. 2017;14(1):15. 10.1186/s10397-017-1018-0 . Tang Mingjun Y, Wenhui Z. Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery. BMC Womens Health. 2023;23(1):85. 10.1186/s12905-022-02118-w . Wahl Kate J, Yong Paul J, Bridge-Cook, Philippa, et al. Endometriosis in Canada: It Is Time for Collaboration to Advance Patient-Oriented, Evidence-Based Policy, Care, and Research. J Obstet Gynecol Can. 2021;43(1):88–90. 10.1016/j.jogc.2020.05.009 . Guan Y, Nguyen AM, Wratten S, et al. The endometriosis daily diary: qualitative research to explore the patient experience of endometriosis and inform the development of a patient-reported outcome (PRO) for endometriosis-related pain. J Patient Rep Outcomes. 2022;6(1):5. 10.1186/s41687-021-00409-8 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5013696","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":352823850,"identity":"dfe84d76-0501-4828-a04e-dcc4f3a8b6fc","order_by":0,"name":"Shunhe Lin","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shunhe","middleName":"","lastName":"Lin","suffix":""},{"id":352823851,"identity":"f2c45110-ab9c-4386-bb81-274ca3a7543e","order_by":1,"name":"Wei Qi","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Qi","suffix":""},{"id":352823852,"identity":"7f34dbb8-a062-454f-957e-2b82a87e755c","order_by":2,"name":"Jinna Zhang","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinna","middleName":"","lastName":"Zhang","suffix":""},{"id":352823853,"identity":"e00a769d-2d49-4c45-bff5-126a67aa65e2","order_by":3,"name":"Chaobin Liu","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chaobin","middleName":"","lastName":"Liu","suffix":""},{"id":352823856,"identity":"43442854-a73d-4ac1-a514-3abc47c35fcc","order_by":4,"name":"Xi Xie","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xi","middleName":"","lastName":"Xie","suffix":""},{"id":352823857,"identity":"e70555f2-9d20-429b-ba56-60e685b12b60","order_by":5,"name":"Zhenna Wang","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhenna","middleName":"","lastName":"Wang","suffix":""},{"id":352823859,"identity":"9a0ef0b0-f74a-437b-8a9e-fee158f5d64d","order_by":6,"name":"Yuyan Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYDADNvbGxgcfGCRI0MLHc/iw4QyStMhJpKVJ8xCjUj4i+Zg0b5tdHhtDjoG0zR+LPP4G5oePbuDRYngDaDhvW3IxG8MZA+PcNoliiQNsxsY5+LTMyDEDamFObGPsMUjObZBIbDjAwyZNhJb6xDZmHoPDFn8kEucT0iIvAdZyOLGNjS2xmYFNInEDIS0GPM+SLeecO57YxsN8mLG3TSJx42ECfpFvTz54401ZdeL8+Q/bf/z4U5c473jzw8d4bTnAwCLByIYsxIxHOdiWBgbmDwx/CKgaBaNgFIyCkQ0AdxBJ35jLP4EAAAAASUVORK5CYII=","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yuyan","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2024-09-01 15:59:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5013696/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5013696/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66946684,"identity":"0e5e16a8-c93f-410b-a2d0-47f402368cc6","added_by":"auto","created_at":"2024-10-18 09:47:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18976,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in Endometriosis Specialty Clinic Outpatient Visits and Hospitalizations (2018-2023).\u003c/p\u003e\n\u003cp\u003eNote: Figure 1 shows the increase in outpatient visits and hospitalizations in the endometriosis specialty clinic from 2018 to 2023, indicating growing demand and effectiveness of the specialized management program.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5013696/v1/ac1855211ecb34de0c5571b0.png"},{"id":66946683,"identity":"64065eca-0140-4612-9865-2c998bc90e46","added_by":"auto","created_at":"2024-10-18 09:47:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28011,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in Patient Satisfaction for Endometriosis Specialty Care (2018-2023)\u003c/p\u003e\n\u003cp\u003eNote: Figure 2 shows the increasing patient satisfaction rates for outpatient and inpatient endometriosis care from 2018 to 2023, based on standardized patient surveys. The rising trend indicates the effectiveness and quality improvement of the specialized management program.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5013696/v1/6eb3abf57ccf45d4d57c5b18.png"},{"id":70353424,"identity":"6f03e318-8b3b-4f89-8ebb-d2c17e5b0729","added_by":"auto","created_at":"2024-12-02 12:17:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757427,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5013696/v1/f570f030-99f2-4c1b-8f9a-981fbfb4f1b6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transforming Endometriosis Management: Insights from a Six-Year Application of the 4P Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis is a chronic gynecological disorder that significantly impacts the health and quality of life of women of reproductive age. It is characterized by the presence of endometrial-like tissue outside the uterus, which can lead to symptoms such as dysmenorrhea, chronic pelvic pain, and infertility [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These clinical manifestations not only cause physical discomfort but also have profound psychological and social consequences, including emotional distress, anxiety, depression, and reduced social functioning [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Managing endometriosis is challenging due to the heterogeneity of symptoms and the complexity of the disease, which often requires long-term and multifaceted treatment strategies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Traditional diagnostic and therapeutic approaches for endometriosis, which primarily rely on hormonal treatments and surgical interventions, often fail to meet the comprehensive needs of patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These methods tend to focus on symptom relief rather than holistic patient care, leading to inconsistent treatment outcomes and frequent recurrence of symptoms. Furthermore, the lack of specialized and coordinated care models results in variability in treatment quality, potentially compromising patient outcomes and satisfaction.\u003c/p\u003e \u003cp\u003eRecognizing these challenges, there has been growing interest in developing specialized management models for endometriosis that prioritize comprehensive and consistent care [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Key strategies include establishing dedicated multidisciplinary medical teams, optimizing diagnostic and therapeutic protocols, and enhancing patient management practices [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These efforts aim to improve overall treatment outcomes by providing tailored, high-quality care. However, traditional management approaches often fall short due to a lack of coordinated care and individualized treatment plans, failing to adequately address the varied and complex manifestations of endometriosis, which leads to less than optimal patient outcomes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response to the limitations of conventional care models, Fujian Maternity and Child Health Hospital has implemented an innovative 4P management model designed to enhance treatment outcomes through systematic and patient-centered care. The 4P model stands for Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement. This approach emphasizes building specialized healthcare teams and implementing targeted training to ensure consistent, high-quality care. It also involves customizing treatment plans based on individual clinical profiles, thereby avoiding a one-size-fits-all approach. By integrating various medical disciplines such as endocrinology, pain management, and psychology, the model offers comprehensive, multidisciplinary care. Additionally, it encourages active participation from patients and their families, promoting adherence to treatment protocols and fostering a sense of responsibility in managing the disease. This holistic and innovative approach not only addresses the physical and psychological aspects of endometriosis but also aims to improve overall patient satisfaction and quality of life.\u003c/p\u003e \u003cp\u003eThis study systematically evaluates the effectiveness of the 4P management model over the past six years at Fujian Maternity and Child Health Hospital. By examining critical outcomes such as follow-up adherence, quality of life, emotional well-being, clinical workload, and patient satisfaction, this research provides valuable insights into the impact of the 4P model in enhancing endometriosis care. The results from this study aim to establish a framework for other healthcare institutions interested in adopting similar specialized management approaches, potentially setting a new benchmark for endometriosis treatment and patient care standards.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study utilized a retrospective analysis of clinical and quality control data from endometriosis patients treated at a tertiary care hospital over the past six years. Data were extracted from the hospital's electronic medical records and patient follow-up databases. Key outcome measures included patient follow-up adherence, quality of life, emotional well-being, specialty clinic workload, and patient satisfaction. These indicators were selected to provide a comprehensive assessment of the effectiveness of the management strategies implemented.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Subjects\u003c/h2\u003e \u003cp\u003eThe study included a clinical observation component, selecting 636 patients who attended the endometriosis specialty clinic between January 2020 and December 2021 were selected as the observation group, while 613 patients from the same period served as the control group. Inclusion criteria were: 1) patients who underwent surgical treatment for endometriosis at the hospital; 2) patients who participated in follow-up visits every 3\u0026ndash;6 months; 3) patients who voluntarily agreed to participate in the study. Exclusion criteria were: 1) patients with severe complications or concurrent internal or surgical diseases; 2) patients unable to commit to long-term follow-up; 3) patients unwilling to participate. This study received approval from the hospital\u0026rsquo;s ethics committee (Ethics Approval Number: 2018-087), and all participants signed informed consent forms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Approach\u003c/h2\u003e \u003cp\u003eThe observation group received a novel 4P management model, which was specifically designed to address the multifaceted needs of endometriosis patients. This model, encompassing Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement, aims to provide a holistic, systematic, and patient-centered approach to treatment. These elements enhance care quality and ensure consistency in endometriosis management.\u003c/p\u003e \u003cp\u003eTo implement the 4P approach, specialized teams were formed, treatment plans were tailored to individual patient needs, multidisciplinary collaboration was emphasized, and active patient and family engagement was encouraged. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the key activities, goals, and expected outcomes associated with each component of the 4P management model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of the 4P Management Model for Endometriosis Care\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4P Management Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKey Activities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGoals\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExpected Outcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessionalized Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Form specialized endometriosis teams\u003c/p\u003e \u003cp\u003e- Provide targeted training\u003c/p\u003e \u003cp\u003e- International collaboration and learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Ensure consistent and high-quality care\u003c/p\u003e \u003cp\u003e- Standardize treatment protocols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e- Improved treatment consistency\u003c/p\u003e \u003cp\u003e- Reduced unnecessary surgeries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonalized Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Tailor treatment plans to individual needs\u003c/p\u003e \u003cp\u003e- Weekly research and training sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Avoid one-size-fits-all approach\u003c/p\u003e \u003cp\u003e- Enhance patient satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e- Better treatment outcomes\u003c/p\u003e \u003cp\u003e- Increased patient satisfaction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePluralistic Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Multidisciplinary collaboration\u003c/p\u003e \u003cp\u003e- Combine pharmacological and surgical interventions\u003c/p\u003e \u003cp\u003e- Regular multidisciplinary meetings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Provide comprehensive care\u003c/p\u003e \u003cp\u003e- Address mental health and prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e- Comprehensive treatment plans\u003c/p\u003e \u003cp\u003e- Improved mental health outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipatory Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Establish holistic care team\u003c/p\u003e \u003cp\u003e- Organize patient education sessions\u003c/p\u003e \u003cp\u003e- Maintain patient database\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Increase patient engagement\u003c/p\u003e \u003cp\u003e- Enhance self-management capabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e- Improved follow-up adherence\u003c/p\u003e \u003cp\u003e- Higher patient satisfaction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the key components, activities, goals, and expected outcomes of the 4P management model for endometriosis care. The model includes Professionalized Management for high-quality care through specialized teams; Personalized Management to tailor treatment to individual needs; Pluralistic Management to incorporate multidisciplinary collaboration; and Participatory Management to enhance patient engagement.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eFollow-up Adherence\u003c/h2\u003e \u003cp\u003eFollow-up adherence was categorized into three distinct groups: complete adherence, partial adherence, and non-adherence. Complete adherence was defined as patients who attended all scheduled follow-up visits according to the prescribed timeline. Partial adherence referred to patients who occasionally missed some follow-up visits but generally participated in the majority of them. Non-adherence was defined as patients who did not participate in any follow-up visits.The chi-square (χ\u0026sup2;) test was employed to compare the adherence rates between the observation group and the control group.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eQuality of Life\u003c/h2\u003e \u003cp\u003eThe VAS was utilized to assess the improvement in patients' pain symptoms over time. VAS is a widely recognized tool that measures pain intensity on a scale, where patients indicated their pain levels at 2, 4, and 6 months following surgery. By analyzing and comparing VAS scores across these different time points, we identified trends in pain reduction, providing insight into the effectiveness of the 4P management model in enhancing the quality of life for patients with endometriosis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eNegative Emotional Disturbances\u003c/h2\u003e \u003cp\u003eChanges in patients' negative emotional states were assessed using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). The SAS measured levels of anxiety, while the SDS evaluated levels of depression. By comparing SAS and SDS scores from before surgery to those taken 6 months post-surgery, we analyzed improvements in negative emotional disturbances.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSpecialty Clinical Workload\u003c/h2\u003e \u003cp\u003eThe changes in the volume of specialty outpatient visits and inpatient admissions were analyzed to evaluate the trend in clinical workload. By comparing the annual growth rates in outpatient visits and inpatient admissions from 2018 to 2023, we assessed the impact of specialty management on clinical workload, highlighting shifts in the burden of work and resource demand associated with the specialty management program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient Satisfaction\u003c/h2\u003e \u003cp\u003ePatient satisfaction data were collected using survey questionnaires completed by both outpatient and inpatient participants. The questionnaires assessed various aspects of care, including the quality of medical services, nursing care, and communication effectiveness. By comparing satisfaction levels over different years, we aimed to evaluate improvements in patient experience associated with the specialized management approach.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 26.0 software. Descriptive statistics, including mean, standard deviation, median, and percentages, were used to summarize the data. Independent sample t-tests or Mann-Whitney U tests were conducted to compare differences between various time points or groups, depending on data distribution and type. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set for all tests, and all statistical tests were two-tailed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImprovement in Follow-up Adherence Among Endometriosis Patients\u003c/h2\u003e \u003cp\u003eThe follow-up adherence rate was significantly higher in the observation group than in the control group. Complete follow-up adherence was observed in 68.9% of the observation group versus 53.8% in the control group. The χ\u0026sup2; test indicated a significant improvement in adherence for the observation group (χ\u0026sup2; = 54.26, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Detailed results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Follow-up Adherence Between Two Groups (n, %)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete Adherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePartial Adherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo Adherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2 Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation (n\u0026thinsp;=\u0026thinsp;636)\u003c/p\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;613)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e438\u003c/p\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: Complete adherence refers to attending all scheduled follow-up visits; partial adherence indicates attending the majority but missing some; no adherence means not attending any follow-up visits. Statistical significance was assessed using the χ\u0026sup2; test, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating significance.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eImprovement in Quality of Life Among Endometriosis Patients\u003c/h2\u003e \u003cp\u003ePatients in the observation group experienced significant pain reduction, with notable decreases in chronic pelvic pain. VAS scores decreased progressively at 2, 4, and 6 months post-surgery, indicating enhanced quality of life in the observation group compared to the control group. Detailed VAS score comparisons are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of VAS Scores Between the Two Groups ( Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD )\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline (Preoperative)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 Months Postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 Months Postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 Months Postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation (n\u0026thinsp;=\u0026thinsp;636)\u003c/p\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;613)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003cp\u003e6.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003cp\u003e3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: VAS scores were used to measure the intensity of pain, with lower scores indicating less pain. The progressive decrease in VAS scores at each postoperative time point demonstrated a significant reduction in pain symptoms for patients in the observation group compared to those in the control group. Statistical significance was assessed using independent t-tests, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eImprovement in Negative Emotional Disturbances in Endometriosis Patients\u003c/h2\u003e \u003cp\u003eEndometriosis patients showed significant improvements in negative emotional disturbances, with steady declines observed in both the SAS and SDS scores over the six months following surgery. The observation group experienced more pronounced improvements compared to the control group at the six-month postoperative mark. The differences between the two groups were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Negative Emotional Disturbance Scores Between the Two Groups (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSDS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline (Preoperative)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 Months Postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 Months Postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 Months Postoperative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation (n\u0026thinsp;=\u0026thinsp;636)\u003c/p\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;613)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003cp\u003e57.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003cp\u003e40.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e \u003cp\u003e60.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e \u003cp\u003e53.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: SAS and SDS scores are used to measure anxiety and depression levels, respectively. Lower scores indicate reduced anxiety and depression symptoms. Statistical significance was determined using appropriate tests, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSteady Increase in Specialized Endometriosis Clinic and Hospitalization Workload\u003c/h2\u003e \u003cp\u003eThe workload of the specialized endometriosis clinic has shown a consistent upward trend over the past six years. Outpatient visits increased significantly, from 574 cases in 2018 to 2,546 cases in 2023. In parallel, the number of hospitalizations also rose, from 432 cases in 2018 to 997 cases in 2023, demonstrating the growing demand for specialized care. These trends are visually represented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eGradual Increase in Patient Satisfaction for Endometriosis Care\u003c/h2\u003e \u003cp\u003eFollowing the establishment of the specialized endometriosis management program, the standards of care have remained high, with no adverse medical events or patient complaints reported within this specialty. Outpatient satisfaction rates rose from 93.2% in 2018 to 97.8% in 2023. Similarly, inpatient satisfaction rates increased from 91.8% in 2018 to 98.6% in 2023, demonstrating a consistent improvement in patient perceptions of care quality. These trends are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCurrent Status and Impact of Endometriosis Specialty Care in China\u003c/h2\u003e \u003cp\u003eEndometriosis is a multifaceted gynecological disorder that profoundly impacts the health and quality of life of women. In response to the escalating demand for specialized care, leading medical institutions have established dedicated endometriosis clinics and specialty centers [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These centers employ cutting-edge diagnostic technologies, such as high-resolution laparoscopy and magnetic resonance imaging (MRI), to enhance diagnostic precision and facilitate personalized therapeutic strategies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Within these specialized settings, laparoscopic surgery has become a standard practice, significantly optimizing the efficiency and outcomes of endometriosis management [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, substantial advancements have been made in pharmacological therapies, including the use of gonadotropin-releasing hormone (GnRH) agonists [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and the novel progestin dienogest [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These pharmacological interventions are effective in controlling symptoms and mitigating recurrence risks, thereby supporting long-term management and enhancing patients' overall quality of life.\u003c/p\u003e \u003cp\u003eDespite these advancements, significant challenges persist in the specialized care of endometriosis in China [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Access to specialized care is predominantly concentrated in top-tier hospitals located in major urban centers, creating barriers for patients residing in smaller cities and rural areas. This uneven distribution of healthcare resources often results in delays in diagnosis and treatment, which can adversely impact overall patient outcomes. Moreover, while sophisticated diagnostic and surgical techniques are available, there is an evident need for more comprehensive care models that holistically address both the physical and psychological dimensions of the disease.\u003c/p\u003e \u003cp\u003eTo bridge these gaps, innovative approaches to endometriosis management are imperative [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The findings of this study indicate that the 4P management model, which encompasses Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement, could provide a robust framework for enhancing endometriosis care. By systematically addressing the multifaceted and heterogeneous needs of endometriosis patients, the 4P model has the potential to refine care delivery, amplify treatment efficacy, and foster a more holistic and integrative approach to patient care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInnovative Aspects and Effectiveness of the 4P Management Model\u003c/h2\u003e \u003cp\u003eThe 4P management model, which integrates Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement, represents a substantial advancement in the holistic management of endometriosis. This study has demonstrated that this multifaceted approach effectively meets the complex needs of endometriosis patients, leading to significant improvements in clinical outcomes, patient satisfaction, and overall quality of care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eProfessionalized Management\u003c/h2\u003e \u003cp\u003eProfessionalized Management focuses on establishing specialized endometriosis care teams, delivering targeted training, and developing standardized treatment protocols [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This structured methodology ensures consistent and high-quality care, effectively addressing the variability commonly observed in conventional care models where patients are required to navigate multiple healthcare providers. Our study revealed a significant increase in follow-up adherence, with rates 15% higher in the observation group than in the control group, demonstrating that professionalized care substantially enhances patient compliance and continuity of care. Furthermore, targeted training and international collaboration have facilitated the adoption of advanced diagnostic and surgical techniques, such as high-resolution laparoscopy. These advancements improve diagnostic precision and therapeutic outcomes, increase treatment consistency, and minimize unnecessary interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003ePersonalized Care\u003c/h2\u003e \u003cp\u003eThe personalized care aspect of the 4P model adapts treatment plans to the unique clinical profiles and specific needs of each patient [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This individualized approach circumvents the limitations of a \"one-size-fits-all\" methodology, which may result in either overtreatment or insufficient care. Our study demonstrated that patients in the observation group showed a marked reduction in pain, as indicated by the continuous decline in VAS scores over the six-month postoperative period. Personalizing treatment not only effectively alleviates physical symptoms but also significantly enhances patient satisfaction by aligning care with individual expectations and health conditions. Through tailored interventions, this model reduces unnecessary surgical procedures, lowers the risk of complications, and improves overall patient outcomes, establishing a new standard for patient-centered care in endometriosis management.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ePluralistic Strategies\u003c/h2\u003e \u003cp\u003eThe pluralistic strategies component of the 4P management model integrates multiple therapeutic modalities and encourages multidisciplinary collaboration [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This comprehensive care framework includes non-invasive imaging techniques, such as MRI and ultrasound, for precise disease assessment, combined with tailored medical and surgical interventions to meet patient needs. Our study showed significant improvements in managing both the physical and psychological symptoms of endometriosis, as evidenced by marked reductions in anxiety and depression scores among patients. Incorporating specialists in endocrinology, pain management, and psychology into the care team ensures a holistic approach, addressing not only the physiological aspects of the disease but also its emotional and psychological impacts [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This multidisciplinary collaboration is essential for managing complex cases of deep infiltrating endometriosis and optimizing long-term management strategies, including the use of hormonal therapies like GnRH agonists and progestins (e.g., dienogest), which have proven effective in symptom control and preventing recurrence [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eParticipatory Involvement\u003c/h2\u003e \u003cp\u003eThe participatory involvement aspect of the 4P model empowers patients by actively engaging them and their families in the care process [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This active participation fosters a sense of responsibility and partnership in disease management, leading to improved treatment adherence and patient satisfaction. Our study found that patient satisfaction rates improved significantly, with outpatient satisfaction reaching 97.8% and inpatient satisfaction at 98.6%. Patient education initiatives, such as workshops and support groups, along with digital tools for health monitoring, play a crucial role in enhancing patient awareness and self-management capabilities. This engagement not only improves clinical outcomes but also enhances the overall healthcare experience, promoting a positive relationship between patients and healthcare providers [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eAddressing Challenges\u003c/h2\u003e \u003cp\u003eDespite the evident success of the 4P management model in enhancing endometriosis care, there are still challenges in scaling this approach across diverse healthcare settings, especially in less resource-rich environments. Expanding access to specialized endometriosis care beyond major urban centers is essential to ensure equitable healthcare delivery. Future efforts should prioritize training healthcare professionals in regional and rural areas, implementing telemedicine for remote consultations, and developing standardized protocols to facilitate the broader adoption of the 4P model. Additionally, continuous research is needed to further refine the model, assess its applicability to other chronic gynecological conditions, and validate its long-term effectiveness. Incorporating patient feedback into care strategies will also be critical for enhancing the model's adaptability and ensuring it meets the evolving needs of patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eBuilding on the insights gained from this study, future research should prioritize conducting randomized controlled trials to establish causality and further validate the effectiveness of the 4P management model. Expanding the implementation of the 4P approach in various healthcare settings, including community hospitals and clinics in rural areas, is essential to ensure broader accessibility and equity in endometriosis care. Investigating the integration of digital health tools, such as mobile apps for patient monitoring and remote consultations, could significantly enhance the scalability and effectiveness of the 4P model. Additionally, international collaboration and knowledge exchange can facilitate the adaptation of the 4P model to meet global standards and practices in endometriosis management.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eStudy Strengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study presents several strengths that contribute to the reliability and robustness of its findings. The large sample size and extended six-year follow-up period provide comprehensive data, enhancing the generalizability of the results. The inclusion of various outcome measures\u0026mdash;such as clinical effectiveness, emotional well-being, and quality of life\u0026mdash;allows for a holistic assessment of the 4P management model\u0026rsquo;s impact. Moreover, the successful integration of multidisciplinary care and patient engagement strategies underscores the potential of the 4P model to address both the physical and psychological aspects of endometriosis, establishing a new standard for patient-centered care.\u003c/p\u003e \u003cp\u003eHowever, the study has certain limitations. It was conducted in a single tertiary hospital, which may limit the generalizability of the findings to other healthcare settings, especially those with fewer resources. The observational nature of the study does not allow for definitive causal inferences, as there may be unmeasured confounding variables. Furthermore, the absence of a randomized controlled trial limits the ability to attribute improvements solely to the 4P intervention. Additionally, patient self-reported outcomes, such as satisfaction and emotional well-being, may be subject to bias, potentially affecting the accuracy of these measures.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe innovative 4P management model presents a transformative approach to endometriosis care, effectively addressing the clinical, emotional, and social dimensions of the disease. By incorporating specialized teams, personalized care plans, multidisciplinary collaboration, and active patient engagement, this model provides a comprehensive solution that not only improves treatment outcomes but also significantly enhances the quality of life for patients. The positive results observed in this study underscore the potential of the 4P model to set a new standard for endometriosis management, offering a scalable framework that can inspire similar approaches in other areas of healthcare.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the participants of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShunhe Lin and Wei Qi conceived of this research. Wei Qi conducted data analysis and drafted the article. Shunhe Lin contributed to the draft and revise the article. Shunhe Lin conducted data compilation and data analysis. Chaobin Liu collected medical histories and surgical procedures. Jinna Zhang and Wei Qi were responsible for follow-up and collecting pregnancy-related information. Yuyan Guo,\u0026nbsp;Zhenna Wang\u0026nbsp;and Xi Xie conducted the organization and implementation of the project and final approval of the version to be published as the corresponding author. All authors approved the manuscript and this submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was sponsored by grants from the Fujian Provincial Natural Science Foundation ( No. 2021J01414 and No. 2021J01421 ) and Fujian provincial health technology project ( No. 2022GGB004 ) of China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Research Ethics Committee of Fujian Maternal and Child Health Hospital (grant number 2021-KRD022). Informed consent was obtained from all resident participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1503/cmaj.220637\u003c/span\u003e\u003cspan address=\"10.1503/cmaj.220637\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSignorile PG, Viceconte R, Baldi A. New Insights in Pathogenesis of Endometriosis. Front Med (Lausanne). 2022;9:879015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmed.2022.879015\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2022.879015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVallv\u0026eacute;-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis. Hum Reprod Update. 2019;25(5):564\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humupd/dmz018\u003c/span\u003e\u003cspan address=\"10.1093/humupd/dmz018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori L, Zaia V, Montagna E, et al. Endometriosis in infertile women: an observational and comparative study of quality of life, anxiety, and depression. BMC Womens Health. 2024;24(1):251. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12905-024-03080-5\u003c/span\u003e\u003cspan address=\"10.1186/s12905-024-03080-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchreurs AMF, Hoefen WM, Dancet EAF, et al. Towards more patient-centred endometriosis care: a cross-sectional survey using the ENDOCARE questionnaire. Hum Reprod Open. 2020;2020(3):hoaa029. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/hropen/hoaa029\u003c/span\u003e\u003cspan address=\"10.1093/hropen/hoaa029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang Y, Wu J, Wang W, et al. Pro-endometriotic niche in endometriosis. Reprod Biomed Online. 2019;38(4):549\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.rbmo.2018.12.025\u003c/span\u003e\u003cspan address=\"10.1016/j.rbmo.2018.12.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlonso Anais,Gunther Kate,Maheux-Lacroix Sarah,et al.Medical management of endometriosis.CURRENT OPINION IN OBSTETRICS \u0026amp; GYNECOLOGY.2024;36 (5): 353\u0026ndash;61.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/GCO.0000000000000983\u003c/span\u003e\u003cspan address=\"10.1097/GCO.0000000000000983\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLibretti A, Dealberti D, Prigione S, Remorgida V. It's never endometriosis, except when it's endometriosis. Acta Biomed. 2023;94(1):e2023010. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.23750/abm.v94i1.13701\u003c/span\u003e\u003cspan address=\"10.23750/abm.v94i1.13701\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsada Marine F, Emilie L, Lise, et al. Interest of multidisciplinary consultation meetings dedicated to endometriosis: From a series of 682 patients. Gynecologie Obstetrique Fertil Senologie. 2024;52(5):336\u0026ndash;42. 10.1016/j. gofs.2024.01.005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMueller Carolin LR, Miguel S, Lukas, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES. Multidisciplinary surgical management of severe posterior compartment endometriosis. 2024;38 (8): 4677\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-024-10969-7\u003c/span\u003e\u003cspan address=\"10.1007/s00464-024-10969-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhashchenko EP, Uvarova EV, Fatkhudinov TK, et al. Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features. J Clin Med. 2023;12(4):1678. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm12041678\u003c/span\u003e\u003cspan address=\"10.3390/jcm12041678\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurghaus Stefanie H, Thomas F, Christine, et al. Standards Used by a Clinical and Scientific Endometriosis Center for the Diagnosis and Therapy of Patients with Endometriosis. Geburtshilfe Frauenheilkd. 2019;79(5):487\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/a-0813-4411\u003c/span\u003e\u003cspan address=\"10.1055/a-0813-4411\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRousset Pascal F, Marie B, Nishat, et al. Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging. 2023;104(3):95\u0026ndash;112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.diii\u003c/span\u003e\u003cspan address=\"10.1016/j.diii\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2022.09.004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei DL-FL, Li-Yuan S et al. The Effect of Perioperative Comprehensive Nursing on Patients Undergoing Ovary Endometriosis Laparoscopic Surgery. ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE. 2024.doi:null.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTucker DR, Noga HL, Lee C, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. Pelvic pain comorbidities associated with quality of life after endometriosis surgery. 2023;229 (2): 147.e1-147.e20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajog.2023.04.040\u003c/span\u003e\u003cspan address=\"10.1016/j.ajog.2023.04.040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitaker LHR, Saraswat L, Horne AW. Combination GnRH antagonists for endometriosis: Balancing efficacy with side effects. Cell Rep Med. 2022;3(9):100748. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.xcrm.2022.100748\u003c/span\u003e\u003cspan address=\"10.1016/j.xcrm.2022.100748\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaglik GB, Topbas SNF, Aydın A et al. Effects of Dienogest Therapy on Endometriosis-Related Dysmenorrhea, Dyspareunia, and Endometrioma Size.Curēus. 2023;15 (1): e34162. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.34162\u003c/span\u003e\u003cspan address=\"10.7759/cureus.34162\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng J, Zhang S, Chen J et al. Long-term trends in the incidence of endometriosis in China from 1990 to 2019: a joinpoint and age-period-cohort analysis. GYNECOLOGICAL ENDOCRINOLOGY. 2021;37 (11): 1041\u0026ndash;1045. doi: 10.1080/ 09513590. 2021. 1975675.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Wang X, Liao K et al. The burden of endometriosis in China from 1990 to 2019. Frontiers in endocrinology. 2022;13: 935931. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fendo\u003c/span\u003e\u003cspan address=\"10.3389/fendo\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2022. 935931.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDanni Z, Zehong Z. Li Rong, Consultation and treatment behaviour of infertile couples in China: a population-based study.REPRODUCTIVE BIOMEDICINE ONLINE. 2019;38 (6): 917\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.rbmo.2018.11.034\u003c/span\u003e\u003cspan address=\"10.1016/j.rbmo.2018.11.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhen more is not better. 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod open. 2019;2019(3):hoz009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/hropen/hoz009\u003c/span\u003e\u003cspan address=\"10.1093/hropen/hoz009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKodaman Pinar H, OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA. Current strategies for endometriosis management. 2015;42 (1): 87\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ogc.2014.10.005\u003c/span\u003e\u003cspan address=\"10.1016/j.ogc.2014.10.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVercellini Paolo D, Agnese O, Federica et al. A stepped-care approach to symptomatic endometriosis management: a participatory research initiative. FERTILITY AND STERILITY. 2018; 109 (6): 1086\u0026ndash;1096. 10.1016/j. fertnstert. 2018. 01. 037.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuggio Laura B, Giussy F, Federica, et al. Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care. Int J women's health. 2017;9:281\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IJWH.S119724\u003c/span\u003e\u003cspan address=\"10.2147/IJWH.S119724\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReid BO, N\u0026aelig;ss-Pleym LE, Bakkelund KE, et al. A cross-sectional study of mental health-, posttraumatic stress symptoms and post exposure changes in Norwegian ambulance personnel. Scand J Trauma Resusc Emerg Med. 2022;30(1):3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13049-021-00991-2\u003c/span\u003e\u003cspan address=\"10.1186/s13049-021-00991-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJulian C, Pal N, Gershon A, et al. Overall survival in patients with advanced non-small cell lung cancer with KRAS G12C mutation with or without STK11 and/or KEAP1 mutations in a real-world setting. BMC Cancer. 2023;23(1):352. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12885-023-10778-6\u003c/span\u003e\u003cspan address=\"10.1186/s12885-023-10778-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmtvedt M, Bean E, Hald K, et al. Patients' and relatives' perspectives on best possible care in the context of developing a multidisciplinary center for endometriosis and adenomyosis: findings from a national survey. BMC Womens Health. 2022;22(1):219. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12905-022-01798-8\u003c/span\u003e\u003cspan address=\"10.1186/s12905-022-01798-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLega F, Rotolo A, Sartirana M. Dealing with pluralism: the managerial work of CEOs in Italian public healthcare organizations. BMC Health Serv Res. 2022;22(1):1222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-022-08567-1\u003c/span\u003e\u003cspan address=\"10.1186/s12913-022-08567-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi N, Yuan M, Li Q, et al. Higher Risk of Anxiety and Depression in Women with Adenomyosis as Compared with Those with Uterine Leiomyoma. J Clin Med. 2022;11(9):2638. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11092638\u003c/span\u003e\u003cspan address=\"10.3390/jcm11092638\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiel PS, Bougie Olga P, Jessica, JOURNAL OF OBSTETRICS AND GYNECOLOGY. Endometriosis and mental health: a population-based cohort study.AMERICAN. 2024;230 (6): 649.e1-649.e19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajog.2024.01.023\u003c/span\u003e\u003cspan address=\"10.1016/j.ajog.2024.01.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarbone MG, Campo G, Papaleo E, et al. The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J Clin Med. 2021;10(8):1616. 10.3390/ jcm10081616.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUgwumadu Lilian C, Rima W-B, Elaine, et al. The role of the multidisciplinary team in the management of deep infiltrating endometriosis. Gynecol Surg. 2017;14(1):15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s10397-017-1018-0\u003c/span\u003e\u003cspan address=\"10.1186/s10397-017-1018-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang Mingjun Y, Wenhui Z. Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery. BMC Womens Health. 2023;23(1):85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12905-022-02118-w\u003c/span\u003e\u003cspan address=\"10.1186/s12905-022-02118-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWahl Kate J, Yong Paul J, Bridge-Cook, Philippa, et al. Endometriosis in Canada: It Is Time for Collaboration to Advance Patient-Oriented, Evidence-Based Policy, Care, and Research. J Obstet Gynecol Can. 2021;43(1):88\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jogc.2020.05.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jogc.2020.05.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuan Y, Nguyen AM, Wratten S, et al. The endometriosis daily diary: qualitative research to explore the patient experience of endometriosis and inform the development of a patient-reported outcome (PRO) for endometriosis-related pain. J Patient Rep Outcomes. 2022;6(1):5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s41687-021-00409-8\u003c/span\u003e\u003cspan address=\"10.1186/s41687-021-00409-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, Specialty Management, 4P Management Approach, Follow-up Adherence, Quality of Life (QoL)","lastPublishedDoi":"10.21203/rs.3.rs-5013696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5013696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eObjective\u003c/b\u003e To systematically evaluate the effectiveness of the 4P management model (Professionalized management, Personalized care, Pluralistic strategies, and Participatory involvement) in the specialty management of endometriosis, and to explore its impact on disease management effectiveness.\u003c/p\u003e \u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e A retrospective analysis was conducted using data collected from January 2018 to December 2023, encompassing outpatient and inpatient workload statistics, as well as patient satisfaction surveys. A total of 636 patients who attended the endometriosis specialty clinic between January 2020 and December 2021 were selected as the observation group, while 613 patients from the same period served as the control group. The observation group received standard care integrated with the 4P management approach. In contrast, the control group was treated with traditional standard care alone. Key study indicators included patient follow-up adherence, quality of life assessments, and evaluations of negative emotional status.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e The observation group demonstrated notable enhancements in follow-up adherence, a significant reduction in visual analogue scale/scores (VAS) for pain, and a marked decrease in negative emotional disturbances. Additionally, clinical workload, both outpatient and inpatient, saw considerable growth, with outpatient visits increasing from 574 cases to 2,546 cases and inpatient admissions rising from 432 cases to 997 cases. Patient satisfaction also improved substantially, with outpatient satisfaction rates climbing from 93.2\u0026ndash;97.8% and inpatient satisfaction rates growing from 91.8\u0026ndash;98.6%.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e The implementation of the 4P management model significantly enhanced patient follow-up adherence, improved quality of life and patient satisfaction, and reduced negative emotional disturbances. This comprehensive approach to managing endometriosis highlights its substantial potential in optimizing specialized care, ensuring consistent and high-quality outcomes. The 4P model offers valuable insights and practical strategies for healthcare institutions seeking to implement innovative and patient-centered management practices in the treatment of endometriosis.\u003c/p\u003e","manuscriptTitle":"Transforming Endometriosis Management: Insights from a Six-Year Application of the 4P Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-18 09:47:37","doi":"10.21203/rs.3.rs-5013696/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"386372a1-9d59-42be-b8ee-5d912fee450e","owner":[],"postedDate":"October 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T12:09:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-18 09:47:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5013696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5013696","identity":"rs-5013696","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}