Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer.
Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer.
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DOI：
10.1097/mlr.0b013e3181bd49ca
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发表时间：
2010-01
期刊：
影响因子：
3
通讯作者：
Hofer TP
中科院分区：
文献类型：
--
作者：
Katz SJ;Hawley ST;Morrow M;Griggs JJ;Jagsi R;Hamilton AS;Graff JJ;Friese CR;Hofer TP
美国医学研究所（Institute of Medicine）呼吁建立更加协调的癌症治疗模式，以配合由癌症提供者和专业组织牵头的倡议。这些举措与正在进行的整合慢性病患者管理的举措并行。我们开发了五种基于慢性护理模型的乳腺癌患者和实践管理过程措施。然后，我们对2005年6月至2007年2月在洛杉矶和底特律诊断为乳腺癌的人群样本的主治外科医生进行了一项调查，以评估这些措施的模式和相关性（N=312，有效率75.9%）。外科医生的实践专业化差异显著，约有一半的外科医生将其总实践的15%或更少用于乳腺癌，而16.2%的外科医生将其总实践的50%或更多用于乳腺癌。在使用患者和实践管理流程的程度上也存在很大差异，大多数外科医生报告使用率较低。患者和实践管理过程措施与更高水平的外科医生专业化和教学计划的存在呈正相关。癌症项目状态与患者和实践管理过程的相关性较弱。在治疗乳腺癌患者的外科医生中，患者和实践管理流程的使用率低可能表明外科医生不相信这些流程重要，或者存在实施的后勤和成本障碍。需要更多的研究来了解患者和实践管理过程的巨大变化如何影响乳腺癌患者的护理质量。
The Institute of Medicine has called for more coordinated cancer care models that correspond to initiatives led by cancer providers and professional organizations. These initiatives parallel those underway to integrate the management of patients with chronic conditions. We developed five breast cancer patient and practice management process measures based on the Chronic Care Model. We then performed a survey to evaluate patterns and correlates of these measures among attending surgeons of a population-based sample of patients diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles and Detroit (N=312, response rate 75.9%). Surgeon practice specialization varied markedly with about half of the surgeons devoting 15% or less of their total practice to breast cancer, while 16.2% of surgeons devoted 50% or more. There was also large variation in the extent of the use of patient and practice management processes with most surgeons reporting low use. Patient and practice management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status was weakly associated with patient and practice management processes. Low uptake of patient and practice management processes among surgeons who treat breast cancer patients may indicate that surgeons are not convinced that these processes matter, or that there are logistical and cost barriers to implementation. More research is needed to understand how large variations in patient and practice management processes might affect the quality of care for patients with breast cancer.