Addressing the challenge of assessing physician-level screening performance: mammography as an example.
Addressing the challenge of assessing physician-level screening performance: mammography as an example.
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DOI：
10.1371/journal.pone.0089418
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Miglioretti DL
中科院分区：
文献类型：
--
作者：
Burnside ES;Lin Y;Munoz del Rio A;Pickhardt PJ;Wu Y;Strigel RM;Elezaby MA;Kerr EA;Miglioretti DL
考虑到评估医生级癌症筛查性能的挑战和错误分类的负面影响，我们提出了一种方法(以乳房X光检查为例)，该方法能够自信地断言性能足够或不充分，或者识别何时需要更多数据。使用已建立的乳房X光检查筛查性能指标-癌症检测率(CDR)和召回率(RR)-以及乳腺癌监测联盟(BCSC)观察到的基准，我们计算出95%确信医生的表现达到或超过基准阈值所需的最小容量。我们以图形方式显示所观察到的最小CDR值和RR值，以自信地断言在一系列解释卷上具有足够的性能。我们使用从BCSC外的临床筛查计划中前瞻性收集的连续乳房X光照片的数据库来说明该方法如何将个体医生的表现归类为体量增加。我们的分析显示，每年2770次筛查乳房X光检查的翻译量，高于美国(US)强制性(480)和平均(1777)年使用量，但低于英格兰强制性(5000)年使用量，才能自信地断言一名医生表现良好。在我们分析的美国实践中，一年的数据一致允许自信地断言，在RR方面表现足够，但CDR不是，这需要在一年多的时间内汇总数据。对于针对低发病率人群的癌症筛查项目中的个人医生质量评估，考虑到由于癌症患者数量较少而观察到的绩效指标的不精确性是重要的。
Motivated by the challenges in assessing physician-level cancer screening performance and the negative impact of misclassification, we propose a method (using mammography as an example) that enables confident assertion of adequate or inadequate performance or alternatively recognizes when more data is required. Using established metrics for mammography screening performance–cancer detection rate (CDR) and recall rate (RR)–and observed benchmarks from the Breast Cancer Surveillance Consortium (BCSC), we calculate the minimum volume required to be 95% confident that a physician is performing at or above benchmark thresholds. We graphically display the minimum observed CDR and RR values required to confidently assert adequate performance over a range of interpretive volumes. We use a prospectively collected database of consecutive mammograms from a clinical screening program outside the BCSC to illustrate how this method classifies individual physician performance as volume accrues. Our analysis reveals that an annual interpretive volume of 2770 screening mammograms, above the United States’ (US) mandatory (480) and average (1777) annual volumes but below England’s mandatory (5000) annual volume is necessary to confidently assert that a physician performed adequately. In our analyzed US practice, a single year of data uniformly allowed confident assertion of adequate performance in terms of RR but not CDR, which required aggregation of data across more than one year. For individual physician quality assessment in cancer screening programs that target low incidence populations, considering imprecision in observed performance metrics due to small numbers of patients with cancer is important.
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DOI：
10.1016/0197-2456(81)90014-3
发表时间：
1981-01-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
CANNER, PL;HUANG, YB;MEINERT, CL
通讯作者：
MEINERT, CL
影响因子：
39.2
作者：
Kerlikowske, K;Carney, PA;Ballard-Barbash, R
通讯作者：
Ballard-Barbash, R
影响因子：
2.9
作者：
Bennett, R. L.;Blanks, R. G.;Moss, S. M.
通讯作者：
Moss, S. M.
影响因子：
19.7
作者：
Jiang, Yulei;Miglioretti, Diana L.;Schmidt, Robert A.
通讯作者：
Schmidt, Robert A.
影响因子：
2.9
作者：
Blanks, RG;Moss, SM;Wallis, MG
通讯作者：
Wallis, MG