Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
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DOI：
10.1136/bmjqs-2019-009742
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发表时间：
2020-02-01
影响因子：
5.4
通讯作者：
Merkow, Ryan P.
中科院分区：
文献类型：
--
作者：
Ellis, Ryan J.;Schlick, Cary Jo R.;Merkow, Ryan P.
背景 当建议化疗时，即使没有接受化疗，化疗质量措施也会考虑医院的合规性。这可能掩盖了癌症护理服务的缺陷。本研究的目的是 (1) 确定与在没有记录禁忌症的情况下未能接受推荐化疗相关的患者因素，以及 (2) 评估未能接受推荐化疗的医院差异。 方法 使用国家癌症数据库识别 2005 年至 2015 年未能接受推荐化疗的乳腺癌、结肠癌和肺癌患者。计算医院层面未能接受推荐化疗的比率，并通过多变量逻辑回归确定与未能接受推荐化疗相关的患者和医院因素。结果 总共分析了 1281 家医院的 183 148 名患者。总体而言，3.5% 的乳腺癌患者、6.6% 的结肠癌患者和 10.7% 的肺癌患者未能接受推荐的化疗。如果没有保险或接受医疗补助，患者接受所有癌症推荐化疗的可能性较小 (p
Background Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy.Methods Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression.Results A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p