Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Urologic Consultants, Grand Rapids, MI.
Urology. 2014 Apr;83(4):781-6. doi: 10.1016/j.urology.2013.11.040.
To assess the effectiveness of a feedback and educational intervention to increase documentation of clinical tumor-node-metastasis (TNM) stage among urologists in a statewide quality improvement collaborative.
The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of urology practices that aims to improve the quality and cost-efficiency of prostate cancer care. In pilot data collection activities, trained abstractors recorded medical record documentation of clinical TNM stage by participating urologists. We compared levels of TNM stage documentation in 12 MUSIC practices at baseline and after performance feedback and a collaborative-wide educational intervention. We examined patient and practice characteristics associated with documentation of TNM stage.
We accrued 491 and 581 men with newly diagnosed prostate cancer during the baseline and postfeedback phases of data collection, respectively. At baseline, 58% of patients had clinical TNM staging in the medical record, ranging from 19% to 96% across 12 practices (P <.05). After the intervention, documentation improved to 79% of patients overall, with 7 individual practices achieving significant improvements (all P <.05). The greatest improvements in documentation occurred among patients treated in smaller practices (ie, 1-4 urologists).
After collaborative review of staging criteria and feedback of baseline performance, urologists in MUSIC practices dramatically improved documentation of clinical TNM stage. This finding underscores the behavioral change possible with the collaborative quality improvement model and ensures the necessary risk stratification data for our ongoing efforts to improve care.
评估反馈和教育干预措施在全州质量改进合作中增加泌尿科医生记录临床肿瘤-淋巴结-转移（TNM）分期的有效性。
密歇根州泌尿外科学术改进合作组织（MUSIC）是一个由泌尿科实践组成的联盟，旨在提高前列腺癌护理的质量和成本效益。在试点数据收集活动中，经过培训的摘要记录员记录了参与泌尿科医生的临床 TNM 分期的病历记录。我们比较了 12 个 MUSIC 实践在基线和反馈后以及全合作范围的教育干预前后的 TNM 分期记录水平。我们检查了与 TNM 分期记录相关的患者和实践特征。
我们分别在基线和反馈后数据收集阶段累计了 491 名和 581 名新诊断为前列腺癌的患者。在基线时，58%的患者的病历中有临床 TNM 分期，12 个实践中的范围从 19%到 96%不等（P <.05）。干预后，总体上有 79%的患者有记录，7 个单独的实践取得了显著的改善（均 P <.05）。记录的最大改善发生在较小实践（即 1-4 名泌尿科医生）治疗的患者中。
在对分期标准进行协作审查和反馈基线表现后，MUSIC 实践中的泌尿科医生大大改善了临床 TNM 分期的记录。这一发现强调了协作质量改进模式下可能发生的行为改变，并确保了我们正在努力改善护理所需的必要风险分层数据。
