Quality-of-care indicators for early-stage prostate cancer
Quality-of-care indicators for early-stage prostate cancer
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DOI：
10.1200/jco.2003.05.157
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发表时间：
2003-05-15
影响因子：
45.3
通讯作者：
Litwin, MS
中科院分区：
文献类型：
--
作者：
Spencer, BA;Steinberg, M;Litwin, MS
有关早期前列腺癌治疗的决定受挫，不仅是因为支持一种治疗方式的证据不足，而且还因为缺乏数据比较提供者之间的质量。事实上，提供者的选择可能与治疗的选择一样重要。我们开展了这项研究，以建立一个评估早期前列腺癌男性患者护理质量差异的基础设施。方法：我们招募了几个来源来制定建议的护理质量指标和协变量的列表。在广泛的结构化文献回顾和与患者及其配偶的一系列焦点小组之后，我们对前列腺癌治疗方面的国家学术领袖进行了结构化访谈。然后，我们召集了一个专家小组，使用兰德共识方法来讨论和评估所提出的质量指标和协变量的有效性和可行性。结果：专家小组批准了49个护理质量指标和14个协变量，这些指标和协变量构成了我们最终的候选指标清单。在选定的指标中代表了几个质量领域，包括患者数量、预转诊、术前测试、病理标本解释和10年无病生存期。协变量包括病例组合的衡量标准，如患者年龄和合并症。结论：这项研究为建立评估早期前列腺癌治疗的护理质量评估工具奠定了基础。下一步是在以人群为基础的样本中实地测试指标的可行性、可靠性、有效性和临床实用性。这项工作将开始为患者及其医生的医疗决策提供信息。(C)2003年，由美国临床肿瘤学会提供。
Decisions regarding treatment for early-stage prostate cancer are frustrated not only by inadequate evidence favoring one treatment modality but also by the absence of data comparing quality among providers. In fact, the choice of provider may be as important as the choice of treatment. We undertook this study to develop an infrastructure to evaluate variations in quality of care for men with early-stage prostate cancer.Methods: We enlisted several sources to develop a list of proposed quality-of-care indicators and covariates. After an extensive structured literature review and a series of focus groups with patients and their spouses, we conducted structured interviews with national academic leaders in prostate cancer treatment. We then convened an expert panel using the RAND consensus method to discuss and rate the validity and feasibility of the proposed quality indicators and covariates.Results: The panel endorsed 49 quality-of-care indicators and 14 covariates, which make up our final list of candidate measures. Several domains of quality are represented in the selected indicators, including patient volume, pretreatment referrals, preoperative testing, interpretation of pathology specimens, and 10-year disease-free survival. Covariates include measures of case-mix, such as patient age and comorbidity.Conclusion: This study establishes a foundation on which to build quality-of-care, assessment tools to evaluate the treatment of early-stage prostate cancer. The next step is to field-test the indicators for feasibility, reliability, validity, and clinical utility in a population-based sample. This work will begin to inform medical decision-making for patients and their physicians. (C) 2003 by American Society of Clinical Oncology.