Variations in quality of care for men with early-stage prostate cancer
Variations in quality of care for men with early-stage prostate cancer
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DOI：
10.1200/jco.2007.13.2555
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发表时间：
2008-08-01
影响因子：
45.3
通讯作者：
Wei, John T.
中科院分区：
文献类型：
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作者：
Spencer, Benjamin A.;Miller, David C.;Wei, John T.
目的质量改进倡议的开始，如绩效工资和医师联盟的绩效改进强调呼吁评估癌症护理的质量在全国代表性样本的患者水平。2000年至2001年从美国外科医生学会国家癌症数据库诊断的前列腺癌病例，并明确审查了来自2，775名男性（加权总数= 55，160例）接受根治性乳房切除术或外束放射治疗。我们确定了符合29质量的护理疾病的具体结构和过程指标制定的兰德，分层的种族，地理区域和医院type.Results总体符合性超过70%的结构和治疗前疾病评估指标，但较低的文件治疗前的功能（46.4%~ 78.4%）、手术病理（37.1%~ 86.3%）、放射技术（62.6%~ 88.3%）和随访（55%）。地理差异被观察为南大西洋分部比新英格兰分部有更高的依从性，至少有一名委员会认证的泌尿科医生（比值比[OR]，9.2; 95% CI，1.9 - 45.0），至少有一名委员会认证的放射肿瘤学家（OR，3.3; 95%CI，1.2至9.0），使用Gleason分级（OR，4.1; 95%CI，1.2至13.8），以及给予总放射剂量≥ 70戈伊（OR，3.1; 95%CI，1.6至6.1）。教学/研究医院和综合性癌症中心有较高的依从性比社区癌症中心，而种族差异没有观察到的任何indicator.Conclusion人口普查部门和医院类型的显着和不必要的变化，这些质量指标说明前列腺癌护理的不一致性，并代表潜在的目标质量改进。没有种族差异表明，一旦病人开始治疗，护理是公平的。
Purpose The commencement of quality-improvement initiatives such as Pay for Performance and the Physician Consortium for Performance Improvement has underscored calls to evaluate the quality of cancer care on a patient level for nationally representative samples.Methods We sampled early-stage prostate cancer cases diagnosed in 2000 through 2001 from the American College of Surgeons National Cancer Data Base and explicitly reviewed medical records from 2,775 men (weighted total = 55,160 cases) treated with radical prostatectomy or external-beam radiation therapy. We determined compliance with 29 quality-of-care disease-specific structure and process indicators developed by RAND, stratified by race, geographic region, and hospital type.Results Overall compliance exceeded 70% for structural and pretherapy disease assessment indicators but was lower for documentation of pretreatment functioning (46.4% to 78.4%), surgical pathology (37.1% to 86.3%), radiation technique (62.6% to 88.3%), and follow-up (55%). Geographic variations were observed as higher compliance in the South Atlantic division than the New England division for having at least one board-certified urologist (odds ratio [OR], 9.2; 95% CI, 1.9 to 45.0), at least one board-certified radiation oncologist (OR, 3.3; 95% CI, 1.2 to 9.0), use of Gleason grading (OR, 4.1; 95% CI, 1.2 to 13.8), and administering total radiation dose >= 70 Gy (OR, 3.1; 95% CI, 1.6 to 6.1). Teaching/research hospitals and Comprehensive Cancer Centers had higher compliance than Community Cancer Centers, whereas racial differences were not observed for any indicator.Conclusion The significant and unwarranted variations observed for these quality indicators by census division and hospital type illustrate the inconsistencies in prostate cancer care and represent potential targets for quality improvement. The lack of racial disparities suggests equity in care once a patient initiates treatment.