Understanding the Challenges of Adjuvant Treatment Measurement and Reporting in Breast Cancer Cancer Treatment Measuring and Reporting
Understanding the Challenges of Adjuvant Treatment Measurement and Reporting in Breast Cancer Cancer Treatment Measuring and Reporting
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DOI：
10.1097/mlr.0b013e3182422f7b
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发表时间：
2013-06-01
期刊：
影响因子：
3
通讯作者：
Franco, Rebeca
中科院分区：
文献类型：
--
作者：
Bickell, Nina A.;McAlearney, Ann Scheck;Franco, Rebeca
背景资料：医疗保健机构和保险公司越来越多地要求报告临床数据，癌症治疗是加强审查的一个领域。Objectives：比较接受与报告的乳腺癌辅助治疗的比率，并评估测量和报告治疗的障碍，以肿瘤登记处（TR）的高容量医疗中心，以医院和社区为基础的肿瘤学家。研究设计：我们使用图表抽象（N = 115）收集的数据计算接受治疗的比率，并将其与TR（N = 535）报告的治疗比率进行比较。我们进行了31个深入的采访，临床和行政线人。询问对TR的看法、当前的报告方法和报告障碍。访谈记录，转录，并使用演绎和归纳的方法进行分析。结果：报告与接受治疗的比率是乳腺癌保乳手术后放射治疗22%对84%（P < 0.0001）; 2或3期化疗：17%对79%（P < 0.0001）; 2或3期激素治疗：1%对91%（P < 0.0001）。比较社区与医院肿瘤学家报告给TR的比率，我们发现以下差异：保乳手术后放射治疗12%与32%（< 0.0001）;化疗8%与29%（< 0.0001）;激素治疗0%与3%（0.09）。我们发现4个关键的障碍来衡量和报告对TR的理解不佳，有限的信息技术能力，沟通不畅，和不信任.Conclusions：努力提高癌症护理质量的改善治疗报告必须克服关键的障碍，特别是那些涉及信息交流和不信任。TR和肿瘤学实践之间的沟通必须改善，以促进更好的治疗测量和报告。
Background: Healthcare accrediting organizations and insurers increasingly require reporting of clinical data, and cancer treatment is one area of enhanced scrutiny.Objectives: To compare rates of received versus reported adjuvant breast cancer treatments, and to assess barriers to measuring and reporting treatments to the tumor registry (TR) of a high-volume medical center with both hospital-based and community-based oncologists.Research Design: We calculated rates of received treatments using data collected using chart abstraction (N = 115) and compared these with rates of reported treatments from the TR (N = 535). We conducted 31 indepth interviews with clinical and administrative informants. Asking about perceptions of the TR, current reporting methods, and reporting barriers. Interviews were recorded, transcribed, and analyzed using deductive and inductive methods.Results: Rates of reported versus received treatments were radiation therapy after breast-conserving surgery 22% versus 84% (P < 0.0001); chemotherapy for stage 2 or 3: 17% versus 79% (P < 0.0001); hormonal therapy for stage 2 or 3: 1% versus 91% (P < 0.0001). Comparing community-based versus hospital-based oncologists' rates reported to the TR, we found the following differences: radiation therapy post-breast conserving surgery 12% versus 32% (< 0.0001); chemotherapy 8% versus 29% (< 0.0001); and hormonal therapy 0% versus 3% (0.09). We found 4 key barriers to measuring and reporting poor understanding about the TR, limited information technology capabilities, poor communication, and mistrust.Conclusions: Efforts to improve cancer care quality by improved treatment reporting must overcome key barriers, especially those involving information exchange and mistrust. Communications between the TR and oncology practices must improve to facilitate better treatment measurement and reporting.