Stanford University Cancer Institute, California, USA.
Health Aff (Millwood). 2012 Apr;31(4):718-28. doi: 10.1377/hlthaff.2011.1295.
Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.
尽管癌症患者的治疗和生存率有所改善，但尚不清楚最佳实践是否能统一提供给患者。我们使用经过验证的质量指标，在密歇根州的 36 家门诊肿瘤学实践联合组织中测量了门诊癌症治疗的质量。我们发现，在整个测量期间，对于乳腺癌和结直肠癌的治疗，有超过 85%的患者接受了高质量的治疗过程。对于临终关怀治疗过程，接受率为 73%，对于症状和毒性管理治疗过程，接受率为 56%。特别是，我们发现癌症疼痛管理这一基本肿瘤学任务方面的治疗存在差异。为了解决质量差距，我们制定了干预措施来提高治疗指南的依从性，改善疼痛管理，并将姑息治疗纳入肿瘤学实践。我们的结论是，承担质量改进活动大部分成本负担的全州联合组织可以将肿瘤学提供者和支付方聚集在一起，以衡量质量并设计干预措施来改善治疗。
