Department of Gynecologic and Obstetrics, Bichat University Hospital, Paris Diderot University, Paris, France,
Department of Gynecologic and Obstetrics, Bichat University Hospital, Paris Diderot University, Paris, France.
Gynecol Obstet Invest. 2020;85(3):222-228. doi: 10.1159/000506048. Epub 2020 Mar 30.
Quality of care is an emerging concern, notably in oncology. The aim of the present study was to identify the sociodemographic factors influencing the quality of care in the USA concerning the surgical management of endometrial cancer (EC) through the Surveillance Epidemiology and End Results (SEER) database using already published Belgian quality indicators (QI).
Using the SEER database 1988-2013, we identified 151,752 patients treated for EC. Six QI were extracted from a Belgian study on quality of care in EC because of their applicability to the SEER. These QI evaluated only the surgical management. We examined the association between sociodemographic characteristics and quality of care with a logistic regression model. We compared our results with those defined as theoretical target by the Belgian initiative and considered a QI to be accurately met if >80% of the population met the indicator, moderately met between 50 and 80%, and poorly met under 50%.
Concerning the 6 surgical QIs, one was accurately met, 3 were moderately met, and 2 were poorly met. For example, 73% of the patients with a high-risk EC underwent a pelvic lymphadenectomy. Age over 75 years old, black ethnicity, lower-income group, without partner, and uninsured had a negative impact on adherence to QIs.
Demographic discrepancies persist in the surgical management of EC, impacting evidence-based care.
医疗质量是一个新兴的关注点，尤其是在肿瘤学领域。本研究的目的是通过使用已经发表的比利时质量指标（QI），利用 Surveillance Epidemiology and End Results（SEER）数据库，确定影响美国子宫内膜癌（EC）手术管理质量的社会人口因素。
我们使用 SEER 数据库（1988-2013 年），确定了 151752 名接受 EC 治疗的患者。由于其在 SEER 中的适用性，从一项关于 EC 护理质量的比利时研究中提取了 6 项 QI。这些 QI 仅评估了手术管理。我们使用逻辑回归模型检查了社会人口特征与护理质量之间的关联。我们将我们的结果与比利时倡议定义的理论目标进行了比较，如果>80%的人群符合指标，则认为 QI 得到了准确满足，如果在 50%至 80%之间，则认为得到了适度满足，如果低于 50%，则认为满足较差。
在 6 项手术 QI 中，有 1 项得到了准确满足，3 项得到了适度满足，2 项满足较差。例如，73%的高危 EC 患者接受了盆腔淋巴结清扫术。年龄超过 75 岁、黑种人、低收入群体、无伴侣和没有保险的人对符合 QI 的情况产生了负面影响。
在 EC 的手术管理中，人口统计学差异仍然存在，影响了循证护理。
