King's College London, Thames Cancer Registry, London, UK.
J Eval Clin Pract. 2011 Jun;17(3):486-92. doi: 10.1111/j.1365-2753.2010.01467.x. Epub 2010 Jul 8.
Recent UK policy has promoted routine monitoring of the performance of cancer services. Clinical databases are one method of collecting the detailed data required for clinically relevant analyses and of supplementing that collected by cancer registries.
To describe characteristics of patients, their treatment and surgical care recorded in the North Thames Prospective Audit of Colorectal Cancer database compared with the Thames Cancer Registry database between 1999 and 2004.
We defined the geographical area served by the prospective audit and extracted a registry dataset for the same area. We compared the numbers, age, sex, cancer site and staging of patients in each database. The proportions recorded as receiving surgery, radiotherapy and chemotherapy were compared over time, and clinical standards recorded for preventing post-operative complications and for specialist care were determined from the clinical database.
Clinical and registry databases differed in case mix. The clinical database began to capture data on a larger number and wider range of patients over time, and generally included more complete staging data. Treatment trends differed between the databases, with the registry data showing lower proportions undergoing surgery and a slight increase in rectal cancer surgery over time. There was a suggestion that a higher proportion of men received radiotherapy and chemotherapy than women. Recording of surgical standards in the clinical database was generally poor, although decreased leak and infection rates and post-operative mortality were suggested in the initial years of the audit.
The clinical database contributed some additional information on patient characteristics and the performance of services, but variable data quality and completeness prevented many planned analyses. Collecting additional data requires funded structures and quality assurance systems and such effort should focus on the data required to answer the most pressing clinical questions.
最近英国的政策提倡对癌症服务的绩效进行常规监测。临床数据库是收集临床相关分析所需的详细数据并补充癌症登记处收集的数据的一种方法。
描述 1999 年至 2004 年期间，在北泰晤士前瞻性结直肠癌审计数据库中记录的患者特征、治疗和手术护理情况，并与泰晤士癌症登记数据库进行比较。
我们定义了前瞻性审计服务的地理区域，并提取了相同区域的登记数据库。我们比较了每个数据库中患者的数量、年龄、性别、癌症部位和分期。随着时间的推移，比较了接受手术、放疗和化疗的比例，并从临床数据库中确定了预防术后并发症和专科护理的临床标准。
临床数据库和登记数据库在病例组合上存在差异。随着时间的推移，临床数据库开始捕获更多数量和更广泛范围的患者的数据，并且通常包含更完整的分期数据。治疗趋势在两个数据库之间存在差异，登记数据库显示接受手术的比例较低，直肠癌手术随着时间的推移略有增加。有迹象表明，接受放疗和化疗的男性比例高于女性。临床数据库中手术标准的记录总体较差，尽管在审计的最初几年，漏诊和感染率以及术后死亡率有所下降。
临床数据库提供了一些关于患者特征和服务绩效的额外信息，但数据质量和完整性存在差异，这使得许多计划中的分析无法进行。收集额外的数据需要有资金支持的结构和质量保证系统，并且这种努力应该集中在回答最紧迫的临床问题所需的数据上。
