Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study.
Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study.
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质量测量在结直肠癌筛查不当使用中的作用：回顾性队列研究。
DOI：
10.1136/bmj.g1247
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kerr,EveA
中科院分区：
文献类型：
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作者：
Saini,SameerD;Vijan,Sandeep;Schoenfeld,Philip;Powell,AdamA;Moser,Stephanie;Kerr,EveA
目的研究结直肠癌筛查的基于年龄的质量测量是否与70-75岁健康状况差的患者过度使用筛查和75岁以上健康状况良好的患者未充分使用筛查有关。美国最大的综合医疗保健系统。设置VA医疗保健系统。退伍军人年龄≥50岁的退伍军人应在财政年度的初级保健访视中进行重复平均风险结直肠癌筛查结果399 067名退伍军人符合纳入/排除标准（平均年龄67岁，97%为男性）。其中，38%的人在24个月内进行了电子记录的筛查。在多变量对数二项回归中，调整了Charlson合并症指数、性别和初级保健就诊次数，筛查在75岁（质量测量使用的年龄截止值）后显著下降（调整后的相对风险为0.35，95%置信区间为0.30至0.40）。一个老兵谁是75岁和不健康的（其中预期寿命可能是有限的，筛选更容易导致净负担或伤害）是更有可能接受筛选比一个老兵76岁和健康（未调整的相对风险1.64，1.36至1.97）。未来的质量措施应侧重于个人的风险/效益，以确保可能受益于服务的患者（无论年龄）获得服务，而那些可能受到伤害的患者则不必接受不必要和昂贵的护理。
ObjectiveTo examine whether the age based quality measure for screening for colorectal cancer is associated with overuse of screening in patients aged 70-75 in poor health and underuse in those aged over age 75 in good health.DesignRetrospective cohort study utilizing electronic data from the Veterans Affairs (VA) Health Care System, the largest integrated healthcare system in the United States.SettingVA Health Care System.ParticipantsVeterans aged ≥50 due for repeat average risk colorectal cancer screening at a primary care visit in fiscal year 2010.Main outcome measuresCompletion of colonoscopy, sigmoidoscopy, or fecal occult blood testing within 24 months of the 2010 visit.Results399 067 veterans met inclusion/exclusion criteria (mean age 67, 97% men). Of these, 38% had electronically documented screening within 24 months. In multivariable log binomial regression adjusted for Charlson comorbidity index, sex, and number of primary care visits, screening decreased markedly after the age of 75 (the age cut off used by the quality measure) (adjusted relative risk 0.35, 95% confidence interval 0.30 to 0.40). A veteran who was aged 75 and unhealthy (in whom life expectancy might be limited and screening more likely to result in net burden or harm) was significantly more likely to undergo screening than a veteran aged 76 and healthy (unadjusted relative risk 1.64, 1.36 to 1.97).ConclusionsSpecification of a quality measure can have important implications for clinical care. Future quality measures should focus on individual risk/benefit to ensure that patients who are likely to benefit from a service receive it (regardless of age), and that those who are likely to incur harm are spared unnecessary and costly care.