Snyder Rebecca A, Mainthia Rajshri, Patel Ravi, Dittus Robert S, Roumie Christianne L
Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA,
Ann Surg Oncol. 2014 Aug;21(8):2476-83. doi: 10.1245/s10434-014-3689-3. Epub 2014 Apr 21.
Nearly 5,000 patients within Veterans Health Administration (VHA) are diagnosed with colorectal cancer (CRC) annually. However, the link between performance on CRC practice guidelines and outcomes is unclear. The purpose of this study was to evaluate quality of CRC care by assessing adherence to National Comprehensive Cancer Network (NCCN) guidelines and to determine if receipt of these metrics was associated with improvement in mortality.
We performed a retrospective cohort study of all patients who underwent resection for nonmetastatic CRC at VHA Tennessee Valley Healthcare System from 2001 to 2010. We defined "excellent" care as receipt of at least 75 % of eligible NCCN metrics. We also examined time to treatment and the relationship between excellent care and mortality.
A total of 331 patients underwent resection for CRC within the study period. Only 47 % of patients received excellent care, and 9 % received 100 % of eligible metrics. The median time from diagnosis to definitive treatment was 22 days [interquartile range (IQR) 12, 41] and 37 days (IQR 24, 56) among colon and rectal cancer patients, respectively. The likelihood of receiving excellent care increased significantly over time. However, there was no association between receipt of excellent care and 5-year all-cause mortality [hazard ratio (HR) 0.85; 95 % CI 0.53-1.36].
Although patients received timely care overall, fewer than half of CRC patients received at least 75 % of eligible NCCN metrics. Although receipt of excellent care was not associated with reduction in all-cause mortality, further research is necessary to identify quality metrics likely to influence patient outcomes.
退伍军人健康管理局（VHA）每年有近5000名患者被诊断为结直肠癌（CRC）。然而，结直肠癌实践指南的执行情况与治疗结果之间的联系尚不清楚。本研究的目的是通过评估对美国国立综合癌症网络（NCCN）指南的依从性来评估结直肠癌护理质量，并确定这些指标的应用是否与死亡率的改善相关。
我们对2001年至2010年在田纳西河谷VHA医疗系统接受非转移性结直肠癌切除术的所有患者进行了一项回顾性队列研究。我们将“优质”护理定义为至少接受75%的符合条件的NCCN指标。我们还研究了治疗时间以及优质护理与死亡率之间的关系。
在研究期间，共有331例患者接受了结直肠癌切除术。只有47%的患者接受了优质护理，9%的患者接受了100%的符合条件的指标。结肠癌和直肠癌患者从诊断到确定性治疗的中位时间分别为22天[四分位间距（IQR）为12,41]和37天（IQR为24,56）。随着时间的推移，接受优质护理的可能性显著增加。然而，接受优质护理与5年全因死亡率之间没有关联[风险比（HR）为0.85；95%可信区间（CI）为0.53 - 1.36]。
虽然患者总体上得到了及时的护理，但不到一半的结直肠癌患者接受了至少75%的符合条件的NCCN指标。虽然接受优质护理与全因死亡率的降低没有关联，但有必要进一步研究以确定可能影响患者治疗结果的质量指标。
