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.
Head Neck. 2019 Oct;41(10):3542-3550. doi: 10.1002/hed.25869. Epub 2019 Jul 11.
To examine associations between quality, short-term and long-term treatment-related outcomes, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC).
We retrospectively evaluated Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 666 patients diagnosed with OPSCC from 2004 to 2007 using multivariate regression and survival analysis. Quality indicators were derived from guidelines for recommended care and performance measures.
Higher quality care was associated with lower risk of death in patients with dysphagia (hazard ratio [HR] = 0.44 [0.32-0.60]), weight loss (HR = 0.42 [0.28-0.62]), gastrostomy (HR = 0.47 [0.33-0.68]), airway obstruction (HR = 0.41 [0.27-0.62]), tracheostomy (HR = 0.17 [0.05-0.67]), and pneumonia (HR = 0.53 [0.33-0.85]). There were no significant differences in mean incremental costs associated with airway and swallowing impairment for patients receiving higher quality care.
Higher quality OPSCC care was associated with improved survival in elderly patients with airway and swallowing impairment. These data suggest that greater adherence to evidence-based guidelines has favorable implications for long-term outcomes.
探讨接受口咽鳞癌（OPSCC）治疗的老年患者的质量、短期和长期治疗相关结局与成本之间的关联。
我们回顾性评估了 2004 年至 2007 年间，通过多变量回归和生存分析，从接受口咽鳞癌治疗的 666 名患者的监测、流行病学和最终结果（SEER）-医疗保险数据中提取质量指标，质量指标来自推荐护理指南和绩效指标。
吞咽困难（风险比[HR] = 0.44 [0.32-0.60]）、体重减轻（HR = 0.42 [0.28-0.62]）、胃造口术（HR = 0.47 [0.33-0.68]）、气道阻塞（HR = 0.41 [0.27-0.62]）、气管切开术（HR = 0.17 [0.05-0.67]）和肺炎（HR = 0.53 [0.33-0.85]）患者的高质量护理与较低的死亡风险相关。对于接受高质量护理的患者，与气道和吞咽障碍相关的平均增量成本没有显著差异。
在有气道和吞咽障碍的老年患者中，较高质量的 OPSCC 护理与生存改善相关。这些数据表明，更严格地遵循循证指南对长期结局有积极影响。
