1] Department of Research, Comprehensive Cancer Centre the Netherlands, Postbus 19079, 3501 DB Utrecht, The Netherlands [2] Department of Health Technology and Services Research, School for Management and Governance, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
1] Department of Research, Comprehensive Cancer Centre the Netherlands, Postbus 19079, 3501 DB Utrecht, The Netherlands [2] Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Br J Cancer. 2014 Feb 18;110(4):850-8. doi: 10.1038/bjc.2013.814. Epub 2014 Jan 14.
Organisational external peer review was introduced in 1994 in the Netherlands to improve multidisciplinary cancer care. We examined the clinical impact of this programme on colorectal cancer care.
Patients with primary colorectal cancer were included from 23 participating hospitals and 7 controls. Hospitals from the intervention group were dichotomised by their implementation proportion (IP) of the recommendations from each peer review (high IP vs low IP). Outcome measures were the introduction of new multidisciplinary therapies and survival.
In total, 45 705 patients were included (1990-2010). Patients from intervention hospitals more frequently received adjuvant chemotherapy for stage III colon cancer. T2-3/M0 rectal cancer patients from hospitals with a high IP had a higher chance of receiving preoperative radiotherapy (OR 1.31, 95% CI 1.11-1.55) compared with the controls and low IP group (OR 0.75, 95% CI 0.63-0.88). There were no differences in the use of preoperative chemoradiation for T4/M0 rectal cancer. Survival was slightly higher in colon cancer patients from intervention hospitals but unrelated to the phase of the programme in which the hospital was at the time of diagnosis.
Some positive effects of external peer review on cancer care were found, but the results need to be interpreted cautiously due to the ambiguity of the outcomes and possible confounding factors.
组织外部同行评议于 1994 年在荷兰引入，旨在改善多学科癌症护理。我们研究了该计划对结直肠癌护理的临床影响。
从 23 家参与医院和 7 家对照医院中纳入原发性结直肠癌患者。干预组的医院根据其对每个同行评议建议的实施比例（高 IP 与低 IP）进行二分法。结局指标为新的多学科治疗方法的引入和生存情况。
共纳入 45705 例患者（1990-2010 年）。来自干预医院的患者更频繁地接受 III 期结肠癌的辅助化疗。高 IP 医院的 T2-3/M0 直肠癌症患者接受术前放疗的可能性更高（OR 1.31，95%CI 1.11-1.55），与对照组和低 IP 组相比（OR 0.75，95%CI 0.63-0.88）。T4/M0 直肠癌症患者术前放化疗的使用率没有差异。来自干预医院的结肠癌患者的生存率略高，但与医院在诊断时所处的计划阶段无关。
外部同行评议对癌症护理有一些积极影响，但由于结果的模糊性和可能存在的混杂因素，结果需要谨慎解释。
