Desch Christopher E, McNiff Kristen K, Schneider Eric C, Schrag Deborah, McClure Joan, Lepisto Eva, Donaldson Molla S, Kahn Katherine L, Weeks Jane C, Ko Clifford Y, Stewart Andrew K, Edge Stephen B
National Comprehensive Cancer Network, Fort Washington, PA, USA.
J Clin Oncol. 2008 Jul 20;26(21):3631-7. doi: 10.1200/JCO.2008.16.5068.
The National Cancer Policy Board recommended the creation of quality measures and a national reporting system in 1999. Representatives from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) collaborated to create metrics suitable for national performance measurement.
Content and methodology experts nominated by ASCO and NCCN met to select and refine metrics for breast, colon, and rectal cancer based on National Initiative for Cancer Care Quality and NCCN measures and NCCN and ASCO guidelines. Measures were selected based on their impact on disease free and overall survival, the degree to which opportunities for improvement exist, and the feasibility of data collection.
Three breast cancer measures and four colorectal cancer measures were chosen. Measures for breast cancer included adjuvant hormone therapy for hormone receptor-positive tumors, chemotherapy for hormone receptor-negative cancer, and radiation after lumpectomy. Colorectal measures included adjuvant radiation and chemotherapy for rectal cancer, and adjuvant chemotherapy for colon cancer. All but one were recommended as accountability measures and one for quality improvement (removal and examination of 12 or more lymph nodes in colon cancer). Specifications were developed for each measure using tumor registries as the data source.
ASCO/NCCN measures can be implemented by health systems, provider groups or payors for improvement or accountability using local tumor registries to furnish data on staging and treatment.
国家癌症政策委员会在1999年建议制定质量指标和国家报告系统。美国临床肿瘤学会（ASCO）和国家综合癌症网络（NCCN）的代表合作制定适用于国家绩效评估的指标。
由ASCO和NCCN提名的内容和方法专家会面，根据国家癌症护理质量倡议、NCCN指标以及NCCN和ASCO指南，选择并完善乳腺癌、结肠癌和直肠癌的指标。根据指标对无病生存期和总生存期的影响、存在改进机会的程度以及数据收集的可行性来选择指标。
选择了三项乳腺癌指标和四项结直肠癌指标。乳腺癌指标包括激素受体阳性肿瘤的辅助激素治疗、激素受体阴性癌症的化疗以及乳房肿瘤切除术后的放疗。结直肠癌指标包括直肠癌的辅助放疗和化疗以及结肠癌的辅助化疗。除一项外，所有指标均被推荐作为问责指标，一项作为质量改进指标（结肠癌切除并检查12个或更多淋巴结）。使用肿瘤登记处作为数据源为每项指标制定了规范。
卫生系统、医疗机构团体或付款方可采用ASCO/NCCN指标，利用当地肿瘤登记处提供分期和治疗数据，以实现改进或问责。
