Gori Davide, Dulal Rajendra, Blayney Douglas W, Brooks James D, Fantini Maria P, McDonald Kathryn M, Hernandez-Boussard Tina
Jt Comm J Qual Patient Saf. 2019 Mar;45(3):217-226. doi: 10.1016/j.jcjq.2018.06.004. Epub 2018 Sep 18.
The shift toward value-based care in the United States emphasizes the role of quality measures in payment models. Many diseases, such as prostate cancer, have a proliferation of quality measures, resulting in resource burden and physician burnout. This study aimed to identify and summarize proposed prostate cancer quality measures and describe their frequency and use in peer-reviewed literature.
The PubMed database was used to identify quality measures relevant to prostate cancer care, and included articles in English through April 2018. A gray literature search for other documents was also conducted. After the selection process of the pertinent articles, measure characteristics were abstracted, and uses were summarized for the 10 most frequently utilized measures in the literature.
A total of 26 articles were identified for review. Of the 71 proposed prostate cancer quality measures, only 47 were used, and less than 10% of these were endorsed by the National Quality Forum. Process measures were most frequently reported (84.5%). Only 6 outcome measures (8.5%) were proposed-none of which were among the most frequently utilized.
Although a high number of proposed prostate cancer quality measures are reported in the literature, few were assessed, and the majority of these were non-endorsed process measures. Process measures were most commonly assessed; outcome measures were rarely evaluated. In a step to close the quality chasm, a "top 5" core set of quality measures for prostate cancer care, including structure, process, and outcomes measures, is suggested. Future studies should consider this comprehensive set of quality measures.
美国向基于价值的医疗模式转变,这凸显了质量指标在支付模式中的作用。许多疾病,如前列腺癌,存在大量的质量指标,这导致了资源负担和医生倦怠。本研究旨在识别和总结已提出的前列腺癌质量指标,并描述其在同行评审文献中的出现频率和应用情况。
使用PubMed数据库识别与前列腺癌护理相关的质量指标,纳入截至2018年4月的英文文章。还对其他文献进行了灰色文献检索。在筛选出相关文章后,提取指标特征,并总结文献中使用最频繁的10项指标的应用情况。
共识别出26篇文章进行综述。在71项已提出的前列腺癌质量指标中,仅47项被使用,其中不到10%得到了国家质量论坛的认可。过程指标报告最为频繁(84.5%)。仅提出了6项结果指标(8.5%),其中没有一项是使用最频繁的指标。
尽管文献中报道了大量已提出的前列腺癌质量指标,但很少有指标得到评估,且其中大多数是未获认可的过程指标。过程指标是最常被评估的;结果指标很少被评价。为了缩小质量差距,建议制定一套“前5名”前列腺癌护理质量核心指标集,包括结构、过程和结果指标。未来的研究应考虑这一全面的质量指标集。