Pearson Marjorie L, Ganz Patricia A, McGuigan Kimberly, Malin Jennifer R, Adams John, Kahn Katherine L
RAND Health and RAND Statistics Group, RAND, Santa Monica, CA 90407-2138, USA.
J Clin Oncol. 2002 Nov 1;20(21):4353-60. doi: 10.1200/JCO.2002.05.527.
The delivery of quality care to all patients with cancer has been named as a national priority within the American health care system. This article addresses the issues critical to case identification in cancer quality measurement and recommends possible strategies for accurately identifying a population of cancer patients.
We present the measurement issues associated with the basic challenges of case identification strategies for quality measurement. We discuss two basic challenges: (1) accurately identifying all patients with the defining characteristics (eg, a diagnosis of breast cancer), and (2) identifying only patients with these characteristics.
Possible options for identifying newly diagnosed patients include using claims or other administrative data, cancer registries, cancer registry rapid case ascertainment, pathology laboratories, and physicians' offices. In the published literature, the sensitivity of claims varies from 75% to 95%, whereas central registries must have a 90% completeness rate to be certified. Most of these approaches, however, involve limitations to obtaining valid and comparable data across multiple settings.
Using an existing data collection system staffed by skilled data collectors and managers should result in substantially more accurate and timely data. Registry officials and the government agencies that provide their support should be encouraged to adopt quality-of-care analyses as an important purpose of the registry system and to enhance their capacity to rapidly ascertain cases, collect the appropriate identifying information needed for patient contact, and verify stage at diagnosis. In order to meet the growing demand for timely, accurate information about quality of care, registries are likely to require additional support so they can enhance their capacity to rapidly ascertain cases, collect the appropriate identifying information needed for patient contact, and verify stage at diagnosis.
为所有癌症患者提供优质护理已被确定为美国医疗保健系统的一项国家优先事项。本文探讨了癌症质量测量中病例识别的关键问题，并推荐了准确识别癌症患者群体的可能策略。
我们阐述了与质量测量病例识别策略的基本挑战相关的测量问题。我们讨论了两个基本挑战：（1）准确识别所有具有定义特征的患者（例如，乳腺癌诊断），以及（2）仅识别具有这些特征的患者。
识别新诊断患者的可能选项包括使用索赔或其他行政数据、癌症登记处、癌症登记处快速病例确定、病理实验室和医生办公室。在已发表的文献中，索赔的敏感性从75%到95%不等，而中央登记处必须达到90%的完整性率才能获得认证。然而，这些方法大多存在跨多个环境获取有效且可比数据的局限性。
使用由熟练的数据收集者和管理者组成的现有数据收集系统应能产生更准确、更及时的数据。应鼓励登记处官员和提供支持的政府机构将护理质量分析作为登记系统的重要目标，并提高其快速确定病例、收集患者联系所需的适当识别信息以及核实诊断阶段的能力。为了满足对及时、准确的护理质量信息日益增长的需求，登记处可能需要额外的支持，以便它们能够提高快速确定病例、收集患者联系所需的适当识别信息以及核实诊断阶段的能力。
