The impact of audit and feedback on nodal harvest in colorectal cancer.
The impact of audit and feedback on nodal harvest in colorectal cancer.
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DOI：
10.1186/1471-2407-11-2
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发表时间：
2011-01-03
期刊：
影响因子：
3.8
通讯作者：
Grunfeld E
中科院分区：
文献类型：
--
作者：
Porter GA;Urquhart R;Bu J;Johnson P;Grunfeld E
结直肠癌中足够的淋巴结收获（≥ 12个淋巴结）已被证明可以优化分期，并被提议作为结直肠癌护理的质量指标。2002年，加拿大新斯科舍省的一个卫生区内的一项审计报告显示，只有22%的患者进行了充分的淋巴结采集。本研究的目的是确定与足够的节点收获相关的因素，特别是检查审计和反馈策略对节点收获的影响。这项基于人群的研究纳入了2001年1月1日至2005年12月31日在加拿大新斯科舍省接受原发性结直肠癌切除术的所有患者。省级癌症登记处与其他数据库（出院，医生索赔数据和全国人口普查数据）的链接提供了临床人口统计学，诊断和治疗事件数据。采用多变量logistic回归分析与充分淋巴结收获相关的因素。年和卫生区之间的具体相互作用进行了检查，以确定以前进行的审计传播的任何潜在影响。在2,322例患者中，中位淋巴结收获为8个;总体而言，719例（31%）获得了充分的淋巴结收获。在多变量分析中，审计的健康地区（p < 0.0001），年份（p <0.0001），年轻年龄（p <0.0001），非急诊手术（p < 0.0001），晚期（p = 0.008）和既往癌症史（p = 0.03）与淋巴结充分收获的可能性增加相关。确定了年度和审计卫生区之间的相互作用（p = 0.006），以便在审计卫生区，随着时间的推移，适当的节点收获量的增加显着更大。随着时间的推移，结直肠癌淋巴结收获确实有所改善。一个公布的审计证明次优节点收获似乎是一个有效的知识翻译工具，虽然更是这样的审计卫生区，审计和反馈策略的潜在有益影响。
Adequate nodal harvest (≥ 12 lymph nodes) in colorectal cancer has been shown to optimize staging and proposed as a quality indicator of colorectal cancer care. An audit within a single health district in Nova Scotia, Canada presented and published in 2002, revealed that adequate nodal harvest occurred in only 22% of patients. The goal of this current study was to identify factors associated with adequate nodal harvest, and specifically to examine the impact of the audit and feedback strategy on nodal harvest. This population-based study included all patients undergoing resection for primary colorectal cancer in Nova Scotia, Canada, from 01 January 2001 to 31 December 2005. Linkage of the provincial cancer registry with other databases (hospital discharge, physician claims data, and national census data) provided clinicodemographic, diagnostic, and treatment-event data. Factors associated with adequate nodal harvest were examined using multivariate logistic regression. The specific interaction between year and health district was examined to identify any potential effect of dissemination of the previously-performed audit. Among the 2,322 patients, the median nodal harvest was 8; overall, 719 (31%) had an adequate nodal harvest. On multivariate analysis, audited health district (p < 0.0001), year (p < 0.0001), younger age (p < 0.0001), non-emergent surgery (p < 0.0001), more advanced stage (p = 0.008), and previous cancer history (p = 0.03) were associated with an increased likelihood of an adequate nodal harvest. Interaction between year and audited health district was identified (p = 0.006) such that the increase in adequate nodal harvest over time was significantly greater in the audited health district. Improvements in colorectal cancer nodal harvest did occur over time. A published audit demonstrating suboptimal nodal harvest appeared to be an effective knowledge translation tool, though more so for the audited health district, suggesting a potentially beneficial effect of audit and feedback strategies.
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影响因子：
9
作者：
Prandi, M;Lionetto, R;Rosso, R
通讯作者：
Rosso, R
影响因子：
9
作者：
Chen, Steven L.;Bilchik, Anton J.
通讯作者：
Bilchik, Anton J.
影响因子：
3.4
作者：
Pheby, DFH;Levine, DF;Shepherd, NA
通讯作者：
Shepherd, NA
影响因子：
5.7
作者：
Grimshaw, J;Eccles, M;Vale, L
通讯作者：
Vale, L
DOI：
10.1093/jnci/djk092
发表时间：
2007-03-21
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Chang, George J.;Rodriguez-Bigas, Miguel A.;Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.