Choosing Wisely in Oncology: Are We Ready For Value-Based Care?
Choosing Wisely in Oncology: Are We Ready For Value-Based Care?
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DOI：
10.1200/jop.2016.019281
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发表时间：
2017-11-01
影响因子：
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通讯作者：
Evans, Tracey
中科院分区：
文献类型：
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作者：
Rocque, Gabrielle;Blayney, Douglas W.;Evans, Tracey
2012年，ASCO创建了五大明智选择（CW）清单，列出了几乎没有证据表明有益的低价值测试和程序。ASCO的肿瘤质量实践倡议是一个肿瘤学家领导的基于实践的质量评估项目，包括基于这些建议的措施。方法对2013年春季和秋季、2014年春季和2015年春季的scw测试数据进行一致性率、一致性随时间的变化以及实践特征的变异性评估。记录的执业特征包括地理位置、学术归属、新病例数量、肿瘤内科医生数量和参与肿瘤质量实践倡议的轮次。计算中位数、四分位数范围和百分比与建议和实践特征的一致性。使用线性回归模型评估推荐一致性随时间的变化。结果2013 - 2015年共有341家独特的肿瘤学实践提取了CW措施。具体建议的性能有所不同。测量1的中位一致性最好（接受化疗的低状态或无记录状态的患者），一致性范围为78.4%至83.3%。最低的一致性是测量3（使用生物标志物或高级影像学检查监测早期乳腺癌），一致性范围为67.7%至74.2%。连续波测量的表现因个人实践而有显著差异。观察到随时间和实践特征的变化。结论ASCO连续超声的表现仍有改进的空间。在不同的实践中，一致性率差异很大。为了改善病人护理和提高价值，需要进一步开展关于连续脑瘫措施的教育。
IntroductionIn 2012, ASCO created the Top Five Choosing Wisely (CW) list of low-value tests and procedures for which there is little evidence of benefit. ASCO's Quality Oncology Practice Initiative, an oncologist-led practice-based quality assessment program, includes measures on the basis of these recommendations.MethodsCW test measures from spring and fall 2013, spring 2014, and spring 2015 were evaluated for concordance rates, change in the concordance over time, and variability by practice characteristics. Practice characteristics recorded included geographic location, academic affiliation, number of new cases, number of medical oncologists, and rounds of participation in Quality Oncology Practice Initiative. Medians, interquartile ranges, and percentages were calculated for concordance with recommendations and practice characteristics. Change in recommendation concordance over time was assessed using linear regression models.ResultsFrom 2013 to 2015, 341 unique oncology practices abstracted the CW measures. Performance varied for specific recommendations. The median concordance was best for measure 1 (patients with low or undocumented performance status who received chemotherapy), where concordance ranged from 78.4% to 83.3%. The lowest concordance was for measure 3 (use of biomarkers or advanced imaging tests for surveillance in early breast cancer), where concordance ranged from 67.7% to 74.2%. Performance on CW measures varied markedly by individual practice. Variability over time and by practice characteristics was observed.ConclusionPerformance on ASCO's CW demonstrates room for improvement. Concordance rates varied substantially by practice. Further education on CW measures is needed to improve patient care and enhance value.