The quality of surgical pathology care for men undergoing radical prostatectomy in the U.S.
The quality of surgical pathology care for men undergoing radical prostatectomy in the U.S.
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在美国接受根治性前列腺切除术的男性的外科病理护理质量
作者：
Miller,DavidC;Spencer,BenjaminA;Shah,RajalB;Ritchey,Jamie;Stewart,AndrewK;Gay,EGreer;Dunn,RodneyL;Wei,JohnT;Litwin,MarkS
背景：作者对接受根治性前列腺癌根治术(RP)治疗的早期前列腺癌患者的全国样本进行了评估，评估了美国病理学家学会(CAP)根治性前列腺切除术(RP)实践方案的依从性。方法通过国家癌症数据库，作者确定了1240名接受根治性前列腺切除术(RP)的全国代表性样本(未加权)。对于每个患者，当地癌症登记员都进行了明确的医疗记录审查，以评估患者水平对7个形态标准(即质量指标)的外科病理报告文件的遵从性。应用CAP预后因素分类框架，计算了以下分析类别的质量指标依从性的综合测量和全有或无测量：1)CAP I类预后因素的严格子集(3个指标)，2)CAP I类因素的广泛子集(6个指标)，以及3)完整的7个指标集。结果在24,420名接受RP的加权样本中，对CAP I类因素的遵从性从54%(95%可信区间[95%CI]，50-58%)变化到病理肿瘤、淋巴结、转移分类(根据美国癌症分期联合委员会)Gleason评分为97%(95%可信区间，96-99%)。在综合分析中，RP病理报告分别包含83%(95%可信区间，81~84%)、85%(95%可信区间，84~87%)和79%(95%可信区间，78~80%)的推荐数据元素，分别由严格的CAP分类I亚集、广义CAP分类I亚集和全套7个指标衡量。与总体较高的综合评分相比，分别只有52%(95%可信区间，48~56%)和41%(95%可信区间，37~45%)的患者在病理报告中完整记录了严格的和宽泛的CAP I类亚集。结论手术病理报告包含了大多数推荐的数据元素；然而，经常没有病理阶段为质量改进提供了机会。癌症2007年。©2007美国癌症协会。
BACKGROUNDThe authors assessed adherence with the College of American Pathologists (CAP) radical prostatectomy (RP) practice protocol in a national sample of men who underwent RP for early‐stage prostate cancer.METHODSUsing the National Cancer Data Base, the authors identified a nationally representative sample of 1240 men (unweighted) who underwent RP. For each patient, local cancer registrars performed an explicit medical record review to assess patient‐level compliance with surgical pathology report documentation of 7 morphologic criteria (ie, quality indicators). Applying the CAP prognostic factor classification framework, composite measures and all‐or‐none measures of quality indicator compliance were calculated for the following analytic categories: 1) a strict subset of CAP category I prognostic factors (3 indicators), 2) a broad subset of CAP category I factors (6 indicators), and 3) the full set of 7 indicators.RESULTSAmong a weighted sample of 24,420 patients who underwent RP, compliance with documentation of the CAP category I factors varied from 54% (95% confidence interval [95% CI], 50–58%) for pathologic tumor, lymph node, metastases classification (according to the American Joint Committee on Cancer staging system) to 97% (95% CI, 96–99%) for Gleason score. In composite, RP pathology reports contained 83% (95% CI, 81–84%), 85% (95% CI, 84–87%), and 79% (95% CI, 78–80%) of the recommended data elements measured by the strict CAP category I subset, the broad CAP category I subset, and the full set of 7 indicators, respectively. In contrast to the generally higher composite scores, only 52% (95% CI, 48–56%) and 41% (95% CI, 37–45%) of men who underwent RP had complete documentation in their pathology reports for the strict and broad CAP category I subsets, respectively.CONCLUSIONSRP surgical pathology reports contained most of the recommended data elements; however, the frequent absence of pathologic stage provides an opportunity for quality improvement. Cancer 2007. © 2007 American Cancer Society.
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影响因子：
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作者：
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DOI：
--
发表时间：
2005
期刊：
影响因子：
--
作者：
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作者：
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影响因子：
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作者：
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影响因子：
45.3
作者：
Spencer, BA;Steinberg, M;Litwin, MS
通讯作者：
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