Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer
Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer
复制标题
DOI：
10.1001/archsurg.2011.141
复制
发表时间：
2011-10-01
影响因子：
--
通讯作者：
Weeks, Jane C.
中科院分区：
文献类型：
--
作者：
Greenberg, Caprice C.;Lipsitz, Stuart R.;Weeks, Jane C.
目的：探讨医疗保险受益人癌症患者接受适当手术治疗的情况。设计：回顾性队列研究。背景：与医疗保险索赔数据相关的国家监测、流行病学和最终结果登记处。患者：在2000年1月至2005年12月间诊断为乳腺癌、结肠癌、胃癌、直肠癌或甲状腺癌的65岁或以上接受过明确手术切除的按服务收费的医疗保险患者。索赔数据是从1999年1月到2007年12月。主要结果测量：总体和医院接受符合外科肿瘤学既定实践指南的护理。结果：11项措施中有7项与指南的符合性大于90%。所有辅助治疗指南的符合率均大于90%。5项节点管理措施中仅有2项的符合率大于90%。至少50%的医院根据11项指南中的6项为100%的患者提供了符合指南的护理。接受适当治疗的患者往往更年轻、更健康、白人、更富裕、病情较轻、生活在中西部。结论：我们发现在肿瘤外科治疗的某些领域与指南高度一致，但在其他领域，特别是在胃和结肠淋巴结管理方面，与指南的一致性远远不够。鉴于目前国家的重点是提高卫生保健质量，外科医生必须注重生成数据，以确定适当的护理，并将这些数据转化为日常实践。
Objective: To investigate receipt of appropriate surgical care in Medicare beneficiaries with cancer.Design: Retrospective cohort study.Setting: National Surveillance, Epidemiology, and End Results registry linked to Medicare claims data.Patients: Fee-for-service Medicare patients aged 65 years or older who underwent a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005. Claims data were available from January 1999 through December 2007.Main Outcome Measures: Receipt of care concordant with established practice guidelines in surgical oncology in the aggregate and by hospital.Results: Concordance with guidelines was greater than 90% for 7 of 11 measures. All guidelines regarding adjuvant therapy had concordance rates greater than 90%. Only 2 of 5 measures for nodal management had concordance rates greater than 90%. At least 50% of hospitals provided guideline-concordant care to 100% of their patients for 6 of 11 guidelines. Patients receiving appropriate care tended to be younger, healthier, white, and more affluent, to have less advanced disease, and to live in the Midwest.Conclusions: We found a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management. Given the current national focus on improving the quality of health care, surgeons must focus on generating data to define appropriate care and translating those data into everyday practice.