Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
Monash University, Melbourne, Victoria, Australia; Monash Health, Clayton, Victoria, Australia; Epworth Healthcare, Richmond, Australia.
HPB (Oxford). 2019 Apr;21(4):444-455. doi: 10.1016/j.hpb.2018.08.016. Epub 2018 Oct 11.
Best practise care optimises survival and quality of life in patients with pancreatic cancer (PC), but there is evidence of variability in management and suboptimal care for some patients. Monitoring practise is necessary to underpin improvement initiatives. We aimed to develop a core set of quality indicators that measure quality of care across the disease trajectory.
A modified, three-round Delphi survey was performed among experts with wide experience in PC care across three states in Australia. A total of 107 potential quality indicators were identified from the literature and divided into five areas: diagnosis and staging, surgery, other treatment, patient management and outcomes. A further six indicators were added by the panel, increasing potential quality indicators to 113. Rated on a scale of 1-9, indicators with high median importance and feasibility (score 7-9) and low disagreement (<1) were considered in the candidate set.
From 113 potential quality indicators, 34 indicators met the inclusion criteria and 27 (7 diagnosis and staging, 5 surgical, 4 other treatment, 5 patient management, 6 outcome) were included in the final set.
The developed indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research in PC care.
最佳实践护理可以优化胰腺癌(PC)患者的生存和生活质量,但有证据表明,一些患者的管理存在差异,护理质量不高。监测实践是进行改进措施的必要基础。我们旨在制定一组核心质量指标,以衡量疾病轨迹中的护理质量。
在澳大利亚三个州拥有广泛 PC 护理经验的专家中进行了改良的三轮 Delphi 调查。从文献中确定了 107 个潜在的质量指标,并将其分为五个领域:诊断和分期、手术、其他治疗、患者管理和结局。专家组又增加了 6 个指标,使潜在的质量指标增加到 113 个。中位数重要性和可行性评分(7-9 分)高且分歧度低(<1)的指标被认为是候选指标。
从 113 个潜在的质量指标中,有 34 个指标符合纳入标准,最终确定了 27 个指标(7 个诊断和分期、5 个手术、4 个其他治疗、5 个患者管理、6 个结局)纳入最终指标集。
所开发的指标集可作为 PC 护理内部质量改进、比较质量报告、公众报告和研究的工具。