Assessing the Quality of a Radiation Oncology Case-Based, Peer-Review Program in an Integrated Academic and Community Cancer Center Network.
Assessing the Quality of a Radiation Oncology Case-Based, Peer-Review Program in an Integrated Academic and Community Cancer Center Network.
复制标题
评估综合学术和社区癌症中心网络中基于病例的放射肿瘤学同行评审计划的质量。
DOI：
10.1200/jop.2015.005983
复制
发表时间：
2016
影响因子：
--
通讯作者：
D. Kuban
中科院分区：
文献类型：
--
作者：
N. Thaker;L. Sturdevant;A. Jhingran;P. Das;M. Delclos;G. Gunn;M. McAleer;W. Tereffe;Seungtaek L. Choi;S. Frank;William J Simeone;W. Martinez;S. Hahn;R. Famiglietti;D. Kuban
目的
学术中心越来越发现有必要定义一个全面的同行审查计划，将高质量的放射治疗(RT)转化为社区网络网站。在这项研究中，我们描述了一个季度质量审计计划的初步结果，该计划旨在改善社区网站上的RT同行审查和提供者教育过程。
材料和方法
社区认证会员(CM)网站使用电子工具输入接受同行审查的患者的临床治疗信息。每名CM医生至少有10%的病人负荷被专家学术人员每季度选择进行审计。质量指标包括对管理计划、技术计划和其他指标的审查。RT评分为符合或不符合机构指南、国家标准或专家判断。
结果
共有719名患者被前四个CM站点输入同行审查数据库。在接受审计的14%的患者中，17%(104人中的18人)被认为不一致。不符合率在常见疾病部位最低，如乳房(16%)、结直肠(14%)和肺部(12%)，而淋巴瘤(50%)、脑(44%)和妇科(27%)的不符合率最高。不足之处包括分期工作不完整，不正确的靶区和正常组织的描绘，以及不遵守公认的剂量-体积限制。
结论
考虑到不符合率很高，我们建议对所有患者进行前瞻性的放疗前同行评审，特别是对来自小容量或复杂疾病部位的患者进行专家评审。一种综合的同行评审方法有望在社区环境中提高癌症治疗的质量、安全性和价值。
PURPOSE
Academic centers increasingly find a need to define a comprehensive peer-review program that can translate high-quality radiation therapy (RT) to community network sites. In this study, we describe the initial results of a quarterly quality audit program that aims to improve RT peer-review and provider educational processes across community sites.
MATERIALS AND METHODS
An electronic tool was used by community-based certified member (CM) sites to enter clinical treatment information about patients undergoing peer review. At least 10% of the patient load for each CM physician was selected for audit on a quarterly basis by expert academic faculty. Quality metrics included the review of the management plan, technical plan, and other indicators. RT was scored as being concordant or nonconcordant with institutional guidelines, national standards, or expert judgment.
RESULTS
A total of 719 patients were entered into the peer-review database by the first four CM sites. Of 14% of patients audited, 17% (18 of 104) were deemed nonconcordant. Nonconcordance rates were lowest in prevalent disease sites, such as breast (16%), colorectal (14%), and lung (12%), whereas rates were highest in lymphoma (50%), brain (44%), and gynecology (27%). Deficiencies included incomplete staging work-up, incorrect target and normal tissue delineation, and nonadherence to accepted dose-volume constraints.
CONCLUSION
Given the high rate of nonconcordance, we recommend prospective, pre-RT peer review of all patients, and, in particular, expert review of patients that are from low-volume or complex disease sites. An integrated approach to peer review holds a promise of improving the quality, safety, and value of cancer therapy in the community setting.