Tanvetyanon Tawee, Lee Ji-Hyun, Fulp William J, Schreiber Fred, Brown Richard H, Levine Richard M, Cartwright Thomas H, Abesada-Terk Guillermo, Kim George P, Alemany Carlos, Faig Douglas, Sharp Philip V, Markham Merry-Jennifer, Malafa Mokenge, Jacobsen Paul B
H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL
H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
J Oncol Pract. 2014 Jul;10(4):e247-54. doi: 10.1200/JOP.2013.001275. Epub 2014 Apr 15.
Audit and feedback have been widely used to enhance the performance of various medical practices. Non-small-cell lung cancer (NSCLC) is one of the most common diseases encountered in medical oncology practice. We investigated the use of audit and feedback to improve the care of NSCLC.
Medical records were reviewed for patients with NSCLC first seen by a medical oncologist in 2006 (n = 518) and 2009 (n = 573) at 10 oncology practices participating in the Florida Initiative for Quality Cancer Care. In 2008, feedback from 2006 audit results was provided to practices, which then independently undertook steps to improve their performance. Sixteen quality-of-care indicators (QCIs) were evaluated on both time points and were examined for changes in adherence over time.
A statistically significant increase in adherence was observed for five of 16 QCIs. Adherence to brain staging using magnetic resonance imaging or computed tomography scan for stage III NSCLC (57.8% in 2006 v 82.8% in 2009; P = .001), availability of chemotherapy flow sheet (89.2% v 97.0%; P < .001), documentation of performance status for stage III and IV disease (43.4% v 51.3%; P < .001), availability of pathology report for patients undergoing surgery (95.2% v 99.2%; P = .02), and availability of signed chemotherapy consent (69.5% v 76.3%; P = .04). There were no statistically significant decreases in adherence on any QCIs.
Audit with feedback was associated with a modest but important improvement in the treatment of NSCLC. Whether these changes are durable will require long-term follow-up.
审核与反馈已被广泛用于提高各种医疗实践的绩效。非小细胞肺癌（NSCLC）是肿瘤内科实践中最常见的疾病之一。我们研究了使用审核与反馈来改善NSCLC的治疗。
回顾了2006年（n = 518）和2009年（n = 573）在参与佛罗里达优质癌症护理倡议的10家肿瘤学实践机构中首次由肿瘤内科医生诊治的NSCLC患者的病历。2008年，向各机构提供了2006年审核结果的反馈，然后各机构独立采取措施改善其绩效。在两个时间点评估了16项护理质量指标（QCI），并检查了随时间推移依从性的变化。
16项QCI中有5项的依从性有统计学显著提高。对于III期NSCLC，使用磁共振成像或计算机断层扫描进行脑分期的依从性（2006年为57.8%，2009年为82.8%；P = 0.001）、化疗流程表的可用性（89.2%对97.0%；P < 0.001）、III期和IV期疾病的性能状态记录（43.4%对51.3%；P < 0.001）、接受手术患者的病理报告可用性（95.2%对99.2%；P = 0.02）以及签署化疗同意书的可用性（69.5%对76.3%；P = 0.04）。任何QCI的依从性均无统计学显著下降。
审核与反馈与NSCLC治疗的适度但重要的改善相关。这些变化是否持久需要长期随访。
