Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
Int J Qual Health Care. 2013 Sep;25(4):418-28. doi: 10.1093/intqhc/mzt041. Epub 2013 Jun 4.
To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan.
A retrospective medical record review.
Eighteen designated cancer care hospitals throughout Japan.
A total of 1685 patients diagnosed with gastric cancer in 2007.
Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan.
Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001).
Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.
开发一套涵盖广泛胃癌治疗方式的医疗流程质量指标（QIs），并考察日本指定癌症治疗医院的当前治疗质量状况。
回顾性病历审查。
日本全国 18 家指定癌症治疗医院。
2007 年确诊为胃癌的 1685 名患者。
根据 29 项 QIs 为符合条件的患者提供护理，这些 QIs 是由日本国内知名专家小组采用 RAND/UCLA（加州大学洛杉矶分校）适宜性方法改编而成。
总体而言，患者接受了 QIs 推荐的 68.3%的治疗流程。虽然 99%的患者在大手术前进行了“深静脉血栓预防”，但只有 12%的患者在“内镜切除前”完成了文件记录。与术前治疗（76%）、手术治疗（66%）和内镜切除（71%）相比，化疗治疗更不可能达到 QI 标准（61%；总体差异：P<0.001）。基于治疗类型的比较表明，文件记录和患者解释的执行频率较低（分别为 60%和 53%），不如 QIs 推荐的诊断和治疗过程常见（85%；总体 P<0.001）。
尽管提供了许多需要的治疗流程，但仍有一些需要改进的领域，特别是在化疗、文件记录和患者解释方面。持续努力提高质量并建立监测这一进展的系统，将有益于日本。
