观察到的与预期的治疗指南依从性之比作为喉癌护理质量指标。
Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
出版信息
Laryngoscope. 2020 Mar;130(3):672-678. doi: 10.1002/lary.28104. Epub 2019 Jun 6.
OBJECTIVES/HYPOTHESIS: To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed-to-expected (O/E) ratio for greater adherence as a risk-adjusted hospital measure of quality care in elderly patients treated for larynx cancer.
STUDY DESIGN
Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data.
METHODS
Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume.
RESULTS
Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (-$3,009 [-$5,226 to -$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals.
CONCLUSIONS
A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care.
LEVEL OF EVIDENCE
NA Laryngoscope, 130:672-678, 2020.
目的/假设：使用观察到的与预期的（O/E）比值来衡量更高的依从性，作为风险调整的医院质量护理指标，以评估接受喉癌治疗的老年患者的生存与依从国家综合癌症网络（NCCN）治疗指南之间的关联。
研究设计
对监测、流行病学和最终结果（SEER）-医疗保险数据进行回顾性分析。
方法
使用多元回归和生存分析评估 2004 年至 2007 年期间被诊断患有喉癌的患者。使用来自 NCCN 指南推荐治疗的质量指标拟合逻辑回归模型，为每个医院计算依从指南的 O/E 比值，并按医院容量分层。
结果
在 395 家医院接受治疗的 1721 名患者中，43.0%的患者接受了 NCCN 指南一致的治疗。低容量医院（N=295）治疗 6 例以下患者 765 例（44.5%），O/E 平均值为 0.96±0.45。O/E＜1（N=32）的治疗例数超过 6 例的医院治疗 284 例（16.5%），O/E 平均值为 0.77±0.18。O/E≥1（N=68）的治疗例数超过 6 例的医院治疗 672 例（39.1%），O/E 平均值为 1.17±0.11。与 O/E＜1（HR=1.00[80%CI：0.70 至 1.24]）和低容量医院的参考组相比，O/E≥1 的医院治疗与生存改善相关（风险比[HR]=0.83[95%置信区间[CI]：0.70 至 0.98]），并且平均增量治疗相关成本降低（-3009 美元[-5226 至-791 美元]）。
结论
NCCN 治疗指南依从性的特定于医院的 O/E，结合最低病例量标准，与老年喉癌患者的生存和治疗相关成本相关，并且可能是喉癌质量护理的可行衡量标准。
证据水平
无 喉镜，130：672-678，2020。
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