Gansler Ted, Fedewa Stacey A, Flanders Dana, Virgo Katherine S, Ward Elizabeth M
J Registry Manag. 2012 Summer;39(2):43-52.
Prior studies reported associations of cancer center facility type and case volume with cancer outcomes (such as survival) and treatment-related processes (such as treatment with chemotherapy, surgery, or radiotherapy).
To determine whether facility characteristics are associated with use of broad (lumped) vs narrow (split) diagnoses in cancer pathology.
We examined associations of facility characteristics and prevalence of broad diagnoses that might adversely affect treatment decisions (based on National Comprehensive Cancer Network treatment guidelines) in National Cancer Data Base records for patients diagnosed from 2004-2008. Logistic regression was used to determine whether associations of facility type and volume with prevalence of broad diagnoses were independent of patient demographic/socioeconomic factors.
Among 10 high incidence cancer sites, 5 had a prevalence of broad diagnoses exceeding 6%. For 4 of these, use of broad diagnoses was independently lower in NCI (National Cancer Institute)- designated comprehensive programs than in community programs, with multivariate prevalence ratios (PR) as low as 0.46 (95% confidence interval [CI] 0.35-0.59) for uterine corpus cancers and 0.49 (95% CI 0.44-0.55) for kidney and renal pelvis cancers. Differences between low- and high-volume facilities were observed for 4 of the 5 sites, with multivariate PR as low as 0.67 (95% CI 0.59-0.77) and 0.72 (95% CI 0.63-0.82) for cancers of the uterine corpus and lung, respectively.
Prevalence of broad cancer diagnoses varies independently by cancer site/type, facility type, and facility volume. Broader diagnoses tend to be used most often by community cancer centers and low-volume centers. This association has implications for use of registry data in pathology quality assessment and quality improvement.
先前的研究报告了癌症中心的设施类型和病例数量与癌症治疗结果（如生存率）以及与治疗相关的过程（如化疗、手术或放疗治疗）之间的关联。
确定设施特征是否与癌症病理学中宽泛（综合）诊断与狭义（细分）诊断的使用情况相关。
我们在国家癌症数据库中，研究了2004年至2008年确诊患者的记录中，设施特征与可能对治疗决策产生不利影响的宽泛诊断患病率之间的关联（基于美国国立综合癌症网络治疗指南）。采用逻辑回归来确定设施类型和规模与宽泛诊断患病率之间的关联是否独立于患者的人口统计学/社会经济因素。
在10个高发病率癌症部位中，有5个部位的宽泛诊断患病率超过6%。其中4个部位，美国国立癌症研究所指定的综合项目中宽泛诊断的使用独立低于社区项目，子宫体癌的多变量患病率比（PR）低至0.46（95%置信区间[CI]0.35 - 0.59），肾和肾盂癌的多变量患病率比为0.49（95%CI 0.44 - 0.55）。在这5个部位中的4个观察到了低容量和高容量设施之间的差异，子宫体癌和肺癌的多变量PR分别低至0.67（95%CI 0.59 - 0.77）和0.72（95%CI 0.63 - 0.82）。
宽泛癌症诊断的患病率因癌症部位/类型、设施类型和设施规模而独立变化。社区癌症中心和低容量中心往往最常使用更宽泛的诊断。这种关联对病理学质量评估和质量改进中登记数据的使用具有影响。
