Use of quality indicators to evaluate the care of patients with localized prostate carcinoma
Use of quality indicators to evaluate the care of patients with localized prostate carcinoma
复制标题
作者：
Miller, DC;Litwin, MS;Wei, JT
背景资料。卫生保健质量保证的目标是保存和改善病人护理。最近，兰德开发了一套基于证据的候选指标，用于评估局限性前列腺癌患者的护理质量；然而，这些指标的可行性和敏感性尚未在临床环境中进行测试。这项研究的目的是评估测量这些质量指标的可行性，并确定它们对随着时间的推移实践模式变化的敏感性。方法：从密歇根大学肿瘤登记中心随机选择168名在1995年或2000年就诊并接受局限性前列腺癌治疗的男性。使用电子数据库审查和显式图表审查相结合的方法来评估衡量每个指标遵从性的可行性。对于评估可行的每个指标，确定两年内患者对RAND指标的遵从性。多因素回归分析调整了疾病分期、肿瘤分级、前列腺特异性抗原(PSA)水平、患者年龄和治疗的潜在混杂影响。结果：根据现有的临床数据，22项兰德候选质量指标中有19项是可行的(86%)。在五项指标中，1995年和2000年在文件编制(遵从性)方面存在显著差异(P<；0.05)。接受的治疗和较高的PSA水平与记录的几个指标的依从性独立相关(P<；0.05)。结论：测量大多数用于治疗局限性前列腺癌患者的兰德质量指标是可行的，并在1995至2000年间观察到几个指标的改善。即使是在一家机构内，这种差异的证明也表明，这些指标足够敏感，可以发现实践模式的差异。(C)2003年美国癌症协会。
BACKGROUND. The goal of quality assurance in health care is to preserve and improve patient care. Recently, RAND developed a set of evidence-based candidate indicators for evaluating the quality of care for patients with localized prostate carcinoma; however, the feasibility and sensitivity of these indicators have not been tested in a clinical setting. The objectives of this study were to evaluate the feasibility of measuring these quality indicators and to determine their sensitivity to change in practice patterns over time.METHODS. One hundred sixty-eight men who presented in either 1995 or in 2000 and were treated for localized prostate carcinoma were selected randomly from the University of Michigan tumor registry. A combination of electronic data base review and explicit chart review was used to assess the feasibility of measuring compliance for each indicator. For each indicator in which assessment was feasible, compliance with the RAND indicators was determined for patients in both years. Multivariate regression analysis was used to adjust for potential confounding effects of disease stage, tumor grade, prostate specific antigen (PSA) level, patient age, and therapy.RESULTS. Based on review of available clinical data, measurement of compliance was feasible for 19 of 22 RAND candidate quality indicators (86%). For five indicators, significant differences in documentation (compliance) were detected between 1995 and 2000 (P < 0.05). Treatment received and higher PSA levels were associated independently with documentation of compliance for several indicators (P < 0.05).CONCLUSIONS. Measurement of the majority of the RAND quality indicators for the treatment of patients with localized prostate carcinoma was feasible, and improvements in several indicators were observed between 1995 and 2000. Demonstration of such variation, even within a single institution, suggests that the indicators are sufficiently sensitive to detect differences in practice patterns. (C) 2003 American Cancer Society.