Klabunde Carrie N, Sancho-Garnier Hélène, Taplin Stephen, Thoresen Steinar, Ohuchi Noriaki, Ballard-Barbash Rachel
National Cancer Institute, Health Services and Economics Branch, Bethesda, MD 20892-7344, USA.
Int J Qual Health Care. 2002 Dec;14(6):449-61. doi: 10.1093/intqhc/14.6.449.
To describe the quality assurance activities related to follow-up evaluation of abnormal screening mammograms and subsequent initial treatment of women determined to have breast cancer for the screening programs represented in the International Breast Cancer Screening Network (IBSN).
Analysis of data from a survey that included questions about screening program policies, standards, and procedures for follow-up of women with abnormal mammograms, as well as the data and measures that programs use to assess the adequacy of follow-up and initial treatment.
IBSN representatives in 23 countries completed a comprehensive questionnaire between May and December 1998.
Two-thirds of IBSN countries reported that they have a written policy or guidelines for follow-up of an abnormal mammogram; 64% require accreditation of the cytology or pathology laboratories that analyze breast specimens, or subject pathology laboratories to external audits. Of the 22 activities and measures related to quality of follow-up and initial treatment that we examined, all countries had in place at least half of them, although countries were more likely to have implemented activities and measures related to data collection and evaluation than to processes of care.
Population-based screening mammography programs cannot achieve the goal of reducing breast cancer mortality if women with abnormal mammograms do not receive appropriate, timely follow-up and initial treatment. This study shows that IBSN countries vary in their implementation of procedures and measures to assure the quality of follow-up and initial treatment for women with abnormal screening mammograms. There is more emphasis on collecting and evaluating data than establishing mechanisms to ensure that the processes of care for follow-up and initial treatment are of high quality.
描述与国际乳腺癌筛查网络（IBSN）所代表的筛查项目中异常乳腺钼靶筛查后续评估及确诊为乳腺癌女性的初始治疗相关的质量保证活动。
对一项调查数据进行分析，该调查包含有关筛查项目针对乳腺钼靶异常女性的随访政策、标准和程序的问题，以及项目用于评估随访和初始治疗充分性的数据和措施。
1998年5月至12月期间，来自23个国家的IBSN代表完成了一份综合问卷。
三分之二的IBSN国家报告称，他们有关于异常乳腺钼靶随访的书面政策或指南；64%的国家要求对分析乳腺标本的细胞学或病理实验室进行认证，或对病理实验室进行外部审核。在我们所考察的与随访和初始治疗质量相关的22项活动和措施中，所有国家至少实施了其中一半，不过各国更倾向于实施与数据收集和评估相关的活动和措施，而非护理流程相关的措施。
如果乳腺钼靶异常的女性未得到适当、及时的随访和初始治疗，基于人群的乳腺钼靶筛查项目就无法实现降低乳腺癌死亡率的目标。本研究表明，IBSN国家在实施确保乳腺钼靶筛查异常女性随访和初始治疗质量的程序和措施方面存在差异。相较于建立机制以确保随访和初始治疗的护理流程具有高质量，各国更侧重于收集和评估数据。
