Cancer Epidemiology and Cancer Services Research Group, Sydney School of Public Health, University of Sydney and Cancer Institute NSW, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
Colorectal Dis. 2014 Jan;16(1):17-25. doi: 10.1111/codi.12399.
Care coordination is an important aspect of the quality of cancer care but is difficult to evaluate due to the lack of valid and reliable measures. This study was conducted to identify a set of objective measures of colorectal cancer care coordination that could be included in a medical record audit tool.
A two-stage Delphi study was conducted to gain consensus among a national panel of experts about the validity of 41 potential indicators of colorectal cancer care coordination that had been identified during a literature review. The expert panel comprised 20 members from the National Health and Medical Research Colorectal Cancer Guidelines Working Party plus representatives from cancer nursing/coordination, general practice and cancer consumers.
Consensus was reached on the validity of 15 of 41 potential indicators, including those that focused on practical aspects of communication (legibility, clarity, content and timeliness of hospital discharge letters, documentation of outcomes of multidisciplinary team meetings) and appropriateness (documentation of preoperative consultation with a stoma therapist, discussions and referrals for adjuvant therapy for appropriate patients, and treatment by an experienced colorectal surgeon). There was lack of consensus on the validity of indicators relating to access to and efficiency of services.
The study has identified a core set of measures considered to be valid indicators of colorectal cancer care coordination. A medical record audit based on these measures could be used to monitor adequacy of cancer care coordination and will complement subjective measures based on self-reported experiences of patients and carers.
护理协调是癌症护理质量的一个重要方面，但由于缺乏有效和可靠的衡量标准，因此难以评估。本研究旨在确定一套可纳入病历审核工具的结直肠癌护理协调客观衡量标准。
采用两阶段德尔菲研究法，在全国专家小组中就 41 项潜在结直肠癌护理协调衡量标准的有效性达成共识，这些标准是在文献回顾中确定的。专家小组由国家卫生和医疗研究结直肠癌指南工作组的 20 名成员以及癌症护理/协调、普通科及癌症患者代表组成。
专家小组就 41 项潜在指标中的 15 项的有效性达成了共识，其中包括侧重于沟通实际方面（医院出院信的清晰度、内容和及时性、多学科团队会议结果的记录）和适当性（记录与造口治疗师的术前咨询、为合适患者进行辅助治疗的讨论和转诊、以及由经验丰富的结直肠外科医生进行治疗）的指标。在与服务获取和效率相关的指标的有效性方面，缺乏共识。
本研究确定了一套被认为是结直肠癌护理协调有效衡量标准的核心指标。基于这些指标的病历审核可用于监测癌症护理协调的充分性，并将补充基于患者和护理人员自我报告的经验的主观衡量标准。
