Compliance with guidelines for patients with bladder cancer: variation in the delivery of care.
Compliance with guidelines for patients with bladder cancer: variation in the delivery of care.
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DOI：
10.1002/cncr.26198
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发表时间：
2011-12-01
期刊：
影响因子：
6.2
通讯作者：
Urologic Diseases in America Project
中科院分区：
文献类型：
--
作者：
Chamie K;Saigal CS;Lai J;Hanley JM;Setodji CM;Konety BR;Litwin MS;Urologic Diseases in America Project
膀胱癌患者管理的临床实践指南包括减少发病率和提高生存率的策略。我们试图根据既定的指南来描述高级别非肌层浸润性膀胱癌患者的实践模式。我们使用监测、流行病学和最终结果（SEER）-Medicare相关数据来确定1992-2002年诊断为高度非肌层浸润性膀胱癌的受试者，这些受试者在未接受明确治疗的情况下存活至少两年（n= 4，545）。我们使用多层次模型来估计患者社会人口统计学、肿瘤和供应商特征与依从性措施的关联和分区变化。在分析的4，545名受试者中，只有一名接受了所有建议的措施。大约42%的医生在两年的时间里没有对一个病人进行过至少一次膀胱镜检查、细胞学检查和一次免疫治疗。1997年后，只有放射学成像（OR 1.19; 95%CI 1.03-1.37）和免疫治疗（OR 1.67; 95%CI 1.39-2.01）的使用显著增加。个体指南指标的外科医生归因变异（膀胱镜检查25%;细胞学59%;放射学成像10%;膀胱内化疗45%;膀胱内免疫治疗26%）促成了这种低依从率。在这个有可能治愈的队列中，指南推荐的治疗明显使用不足。无法解释的提供者一级的因素在很大程度上促成了这一低遵守率。未来的研究，确定障碍和调制器的供应商级采用的指南是至关重要的，以改善护理膀胱癌患者。
Clinical practice guidelines for the management of patients with bladder cancer encompass strategies that minimize morbidity and improve survival. We sought to characterize practice patterns in patients with high-grade non-muscle-invasive bladder cancer in relation to established guidelines. We used Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data to identify subjects diagnosed with high-grade non-muscle-invasive bladder cancer in 1992–2002 who survived at least two years without undergoing definitive treatment (n=4,545). We used multilevel modeling to estimate the association and partitioned variation of patient sociodemographic, tumor, and provider characteristics with compliance measures. Of 4,545 subjects analyzed, only one received all the recommended measures. Approximately 42% of physicians have not performed on a single patient nested within their practice in a two-year period, at least one cystoscopy, cytology and a single instillation of immunotherapy. After 1997, only utilization of radiographic imaging (OR 1.19; 95% CI 1.03–1.37) and instillation of immunotherapy (OR 1.67; 95% CI 1.39–2.01) significantly increased. Surgeon-attributable variation for individual guideline measures (cystoscopy 25%; cytology 59%; radiographic imaging 10%; intravesical chemotherapy 45%; and intravesical immunotherapy 26%) contributes to this low-compliance rate. There is marked underuse of guideline-recommended care in this potentially curable cohort. Unexplained provider-level factors significantly contribute to this low-compliance rate. Future studies that identify barriers and modulators of provider-level adoption of guidelines are critical to improving care for patients with bladder cancer.
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DOI：
10.1093/jnci/95.8.588
发表时间：
2003-04-16
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Schrag, D;Hsieh, LJ;Begg, CB
通讯作者：
Begg, CB
影响因子：
6.6
作者：
OOSTERLINCK, W;KURTH, KH;SYLVESTER, R
通讯作者：
SYLVESTER, R
影响因子：
6.6
作者：
Rajala, P;Liukkonen, T;Lukkarinen, O
通讯作者：
Lukkarinen, O
影响因子：
6.2
作者：
Madeb, Ralph;Golijanin, Dragan;Messing, Edward M.
通讯作者：
Messing, Edward M.
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL