Closing the Quality Loop: Facilitating Improvement in Oncology Practice Through Timely Access to Clinical Performance Indicators
Closing the Quality Loop: Facilitating Improvement in Oncology Practice Through Timely Access to Clinical Performance Indicators
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DOI：
10.1200/jop.2012.000818
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发表时间：
2013-09-01
影响因子：
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通讯作者：
Sawka, Carol
中科院分区：
文献类型：
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作者：
Srigley, John;Lankshear, Sara;Sawka, Carol
目的：呼吁卫生保健组织和专业人员制定明确和透明的质量衡量标准，并展示如何将数据应用于系统和提供者两级的绩效改进。材料和方法：安大略癌症护理中心（CCO）发起了一项病理报告项目，旨在通过标准化报告的内容、格式和向中央注册中心的传输来提高癌症病理报告的质量，并使信息可用于规划、质量测量和质量改进。这项以人口为基础的质量改善项目涉及400多名安大略省病理学家和100多家医院。开发并共享了使用最新可用数据的临床相关质量指标。系统病理数据在报告撰写时以电子方式捕获，并用于自动及时生成临床表现指标，以支持外科肿瘤学质量的提高。这些报告提供了组织、区域和人口各级的比较数据。结果：每月质量指标报告生成并分发到每个癌症中心，并用于在专业，组织和区域层面上就循证质量改进机会进行对话。项目实施以来，结直肠淋巴结恢复率由76%提高到87%，pT2前列腺切除术切缘阳性率由37%下降到21%。结论：高质量、完整的肿瘤病理报告不仅对当代肿瘤学实践很重要，而且对病理信息的次要使用者，包括肿瘤登记处、卫生规划人员、流行病学家和其他参与质量改进活动和研究的人也很重要。
Purpose: Health care organizations and professionals are being called on to develop clear and transparent measures of quality and to demonstrate the application of the data to performance improvement at the system and provider levels.Materials and Methods: Cancer Care Ontario (CCO) initiated a pathology reporting project aimed at improving the quality of cancer pathology by standardizing the content, format, and transmission of reports to a central registry and enabling the information to be available for planning, quality measurement, and quality improvement. This population-based quality-improvement project involved more than 400 Ontario pathologists and more than 100 hospitals. Clinically relevant quality indicators that used the newly available data were developed and shared. Synoptic pathology data were electronically captured at the point of report development and used to automate the timely generation of clinical performance indicators that support quality improvement in surgical oncology. These reports provided comparison data at the organizational, regional, and population levels.Results: Monthly quality indicator reports are generated and distributed to each cancer center and are used to generate dialogue at the professional, organizational, and regional levels regarding evidence-informed quality-improvement opportunities. Since the launch of the project, colorectal lymph node retrieval rates have increased from 76% to 87%, and pT2 prostatectomy margin positivity rates have decreased from 37% to 21%.Conclusion: High-quality, complete cancer pathology reports are important not only for contemporary oncological practice, but also for secondary users of pathology information including tumor registries, health planners, epidemiologists, and others involved in quality-improvement activities and research.