Redondo Maximino, Rivas-Ruiz Francisco, Guzman-Soler M Carmen, Labajos Carlos
Research Unit, Hospital Costa del Sol, Marbella, Malálaga, Spain.
J Eval Clin Pract. 2008 Dec;14(6):1026-30. doi: 10.1111/j.1365-2753.2007.00937.x.
Hospital registers of tumours provide, on a continuous basis, information on differences in patterns of neoplasias and the results of the treatment strategies employed.
In view of the scant publications on measures of health care quality in hospital tumour registers, the aim of our paper is to present the outcome of a study to monitor the results related to health care quality in oncology.
Data are presented for cases recorded at the Hospital Costa del Sol over a period of 8 years. The sources of information are fundamentally the patient's medical record and the database of the Pathology Department.
A high proportion of patients (mean 50%, range 45-68%) were admitted to the hospital by the Emergency Department; there was a notably long delay between the appearance of the first symptoms and the occasion of the first hospital visit (median 65 days; range 60-75 days). Particularly striking was the corresponding delay for breast cancer patients, in most cases superior to 3 months. As was the case for the percentage of admissions by the Emergency Department, most of the indicators evaluated in this study present a significant improvement compared with the initial years of the Hospital Register of Tumours. Thus, non anatomic-pathological diagnoses represented around 7% (range 3-13%), while 43% of patients (range 28-57%) were given adjuvant treatment in the form of radiation therapy or chemotherapy. In 40% of cases (range 20-50%), the tumour stage was included in the clinical record by the doctor who was treating the patient (in the remaining cases, these data were recorded by the Tumour Registry); the date of appearance of the first symptoms was included in the medical record in 65% of cases (range 54-80%). According to the stage classification, the following 5-year survival rates were recorded: (I) 98%, (II) 94%, (III) 69% and (IV) 39% for breast cancer; (I) 93%, (II) 83%, (III) 68% and (IV) 12% for cancer of the colon; and (I) 100%, (II) 94%, (III) 79% and (IV) 53% for prostate cancer.
The high percentage of patients admitted by the Emergency Department and the long delay between the appearance of the first symptoms reflect the deficient attention paid to this problem by patients and by primary health care services. Our results suggest that the Hospital Register of Tumours could constitute an excellent tool for monitoring the quality of health care systems for oncological patients.
肿瘤医院登记册持续提供有关肿瘤形成模式差异以及所采用治疗策略结果的信息。
鉴于关于医院肿瘤登记册中医疗质量衡量指标的出版物较少，我们本文的目的是展示一项监测肿瘤医疗质量相关结果的研究成果。
呈现了在太阳海岸医院8年期间记录的病例数据。信息来源主要是患者的病历和病理科数据库。
很大比例的患者（平均50%，范围45 - 68%）由急诊科收治入院；首次症状出现到首次就诊之间存在明显较长的延迟（中位数65天；范围60 - 75天）。特别显著的是乳腺癌患者相应的延迟，在大多数情况下超过3个月。与肿瘤医院登记册最初几年相比，本研究中评估的大多数指标都有显著改善，情况与急诊科收治患者的百分比类似。因此，非解剖病理诊断约占7%（范围3 - 13%），而43%的患者（范围28 - 57%）接受了放疗或化疗形式的辅助治疗。在40%的病例中（范围20 - 50%），肿瘤分期由治疗患者的医生记录在临床记录中（其余病例中，这些数据由肿瘤登记处记录）；65%的病例（范围54 - 80%）的病历中包含了首次症状出现的日期。根据分期分类，记录了以下5年生存率：乳腺癌（I期）98%，（II期）94%，（III期）69%，（IV期）39%；结肠癌（I期）93%，（II期）83%，（III期）68%，（IV期）12%；前列腺癌（I期）100%，（II期）94%，（III期）79%，（IV期）53%。
急诊科收治患者的高比例以及首次症状出现后的长时间延迟反映出患者和初级医疗服务对此问题的关注不足。我们的结果表明，肿瘤医院登记册可构成监测肿瘤患者医疗系统质量的优秀工具。
