Risk factors for metastatic prostate cancer: A sentinel event case series.
Risk factors for metastatic prostate cancer: A sentinel event case series.
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转移性前列腺癌的危险因素：哨兵事件病例系列。
DOI：
10.1002/pros.23396
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Kanarek,NormaF
中科院分区：
文献类型：
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作者：
Paller,ChanningJ;Cole,AlexanderP;Partin,AlanW;Carducci,MichaelA;Kanarek,NormaF
背景根本原因分析是一种用于评估与“哨兵事件”--医疗系统内严重不良事件--相关的系统因素的技术。这种技术通常用于识别导致这些不良事件发生的因素，以确定需要改进的目标领域，并改善医疗保健服务系统。我们试图将这项技术应用于患有转移性前列腺癌（PCa）的男性患者。MethodsWe对15名在约翰霍普金斯西德尼·金梅尔综合癌症中心患有转移性疾病的患者进行了深入的病例系列分析，使用根本原因分析来完善导致当前时代晚期表现的健康系统因素列表。缺乏常规PSA检测、合并症、患者不愿随访可采取措施的PSA和侵袭性疾病。三名患者患有侵袭性疾病，尽管进行了常规筛查，但在疾病过程的早期阶段不会被发现。然而，其余12例照明的卫生系统因素的分析导致缺失的重要诊断信息，这可能会导致诊断前列腺癌在一个可治愈的stage.ConclusionsThe案件有助于突出需要系统为基础的方法来早期诊断前列腺癌。在我们的一系列患者中发现了一组异质性的早期诊断障碍，包括经济，卫生系统和文化因素。这些发现强调了需要采取个体化方法来防止PCa的延迟诊断。虽然受我们的单一机构范围的限制，但这种方法为研究和质量改进计划提供了一个模型，以识别阻碍PCa适当诊断的可修改系统因素。
BackgroundRoot cause analysis is a technique used to assess systems factors related to “sentinel events”—serious adverse events within healthcare systems. This technique is commonly used to identify factors, which allowed these adverse events to occur, to target areas for improvement and to improve health care delivery systems. We sought to apply this technique to men presenting with metastatic prostate cancer (PCa).MethodsWe performed an in‐depth case series analysis of 15 patients, who presented with metastatic disease at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center using root cause analysis to refine a list of health system factors that lead to late stage presentation in the current era.ResultsKey factors in late diagnosis of PCa included lack of insurance, lack of routine PSA testing, comorbidities, reticence of patients to follow up actionable PSA, and aggressive disease. Three patients had aggressive disease that would not have been discovered at an early stage in the disease process, despite routine screening. However, analysis of the remaining 12 patients illuminated health system factors led to missing important diagnostic information, which might have led to diagnosis of PCa at a curable stage.ConclusionsThe cases help highlight the need for systems based approaches to early diagnosis of PCa. A heterogeneous group of barriers to early diagnosis were identified in our series of patients including economic, health systems, and cultural factors. These findings underscore the need for individualized approaches to preventing delayed diagnosis of PCa. While limited by our single‐institution scope, this approach provides a model for research and quality improvement initiatives to identify modifiable systems factors impeding appropriate diagnoses of PCa.