Earle Craig C, Park Elyse R, Lai Bonnie, Weeks Jane C, Ayanian John Z, Block Susan
Division of Population Sciences Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
J Clin Oncol. 2003 Mar 15;21(6):1133-8. doi: 10.1200/JCO.2003.03.059.
To explore potential indicators of the quality of end-of-life services for cancer patients that could be monitored using existing administrative data.
Quality indicators were identified and assessed by literature review for proposed indicators, focus groups with cancer patients and family members to assess candidate indicators and generate new ideas, and an expert panel ranking the meaningfulness and importance of each potential indicator using a modified Delphi approach.
There were three major concepts of poor quality of end-of-life cancer care that could be examined using currently-available administrative data (such as Medicare claims): institution of new anticancer therapies or continuation of ongoing treatments very near death; a high number of emergency room visits, inpatient hospital admissions, or intensive care unit days near the end of life; and a high proportion of patients never enrolled in hospice, only admitted in the last few days of life, or dying in an acute-care setting. Concepts such as access to psychosocial and other multidisciplinary services and pain and symptom control are important and may eventually be feasible, but they cannot currently be applied in most data systems. Indicators based on limiting the use of treatments with low probability of benefit or indicators based on economic efficiency were not acceptable to patients, family members, or physicians.
Several promising claims-based quality indicators were identified that, if found to be valid and reliable within data systems, could be useful in identifying health-care systems in need of improving end-of-life services.
探索可利用现有行政数据进行监测的癌症患者临终服务质量潜在指标。
通过对拟议指标进行文献综述、与癌症患者及其家属进行焦点小组讨论以评估候选指标并提出新想法，以及由专家小组采用改良德尔菲法对每个潜在指标的意义和重要性进行排名，来确定和评估质量指标。
临终癌症护理质量差主要有三个概念，可利用现有行政数据（如医疗保险理赔数据）进行审查：在临近死亡时启用新的抗癌疗法或继续进行现有治疗；临终时急诊就诊、住院或重症监护天数较多；从未登记接受临终关怀、仅在生命最后几天入院或在急症护理机构死亡的患者比例较高。诸如获得心理社会和其他多学科服务以及疼痛和症状控制等概念很重要，最终可能可行，但目前在大多数数据系统中无法应用。基于限制使用获益可能性低的治疗方法的指标或基于经济效率的指标，患者、家属或医生都无法接受。
确定了几个有前景的基于理赔数据的质量指标，如果在数据系统中被证明有效且可靠，可用于识别需要改善临终服务的医疗保健系统。
