Department of Radiation Oncology, West Virginia University, Morgantown, WV.
School of Medicine, West Virginia University, Morgantown, WV.
JCO Oncol Pract. 2020 Aug;16(8):e829-e834. doi: 10.1200/JOP.19.00593. Epub 2020 May 8.
To determine if a quality improvement (QI) initiative could enhance multidisciplinary management of acute malignant extradural spinal cord compression (ESCC) at our institution.
The medical records of all 40 patients who received palliative radiotherapy for malignant ESCC from 2015 to 2017 were reviewed to determine the time course of key National Comprehensive Cancer Network guideline-supported workup and management steps. On the basis of the findings, a multidisciplinary group of physician stakeholders developed a clinical pathway to facilitate expedited care. The efficacy of this clinical pathway and the educational content provided to all relevant departments were then evaluated by comparing outcomes with data from a similarly reviewed follow-up cohort of 25 patients from 2018 to 2019.
Patients treated for malignant ESCC after our QI intervention were more likely to undergo magnetic resonance imaging (MRI) of the entire spine (64% 44%; = .013) and have a radiation oncology (RO) consultation before surgery (100% 27%; = .002). Median time from MRI to RO consultation decreased from 3 to 1 days ( = .03). On subgroup analysis, initial trends toward delays in RO consultation for patients planning for surgery (median, 3 days) or for lack of prior cancer diagnosis (median, 4 days) were reduced to delays of 0 and 1 day, respectively, after the QI intervention. No significant differences were observed in time to surgical consultation or surgery itself.
This QI study was able to stimulate better use of diagnostic imaging and earlier involvement of RO in multidisciplinary decision making, suggesting an effective approach to improving multidisciplinary care in other scenarios as well.
确定质量改进（QI）举措是否可以提高我院急性恶性硬膜外脊髓压迫症（ESCC）的多学科管理水平。
回顾了 2015 年至 2017 年接受姑息性放疗的 40 例恶性 ESCC 患者的病历，以确定符合国家综合癌症网络指南的关键检查和管理步骤的时间流程。在此基础上，一组多学科的医生利益相关者制定了临床路径，以促进快速护理。然后，通过比较来自 2018 年至 2019 年同样接受审查的后续 25 例患者的数据，评估了该临床路径的效果以及向所有相关科室提供的教育内容。
在我们的 QI 干预之后，接受恶性 ESCC 治疗的患者更有可能接受整个脊柱的磁共振成像（MRI）（64% 比 44%； =.013），并且在手术前更有可能接受放射肿瘤学（RO）咨询（100% 比 27%； =.002）。从 MRI 到 RO 咨询的中位时间从 3 天缩短至 1 天（ =.03）。在亚组分析中，对于计划手术的患者（中位数为 3 天）或缺乏先前癌症诊断的患者（中位数为 4 天），RO 咨询的初始延迟趋势减少到 QI 干预后的 0 天和 1 天。手术咨询或手术本身的时间没有明显差异。
这项 QI 研究能够刺激更好地使用诊断成像，并更早地让 RO 参与多学科决策，这表明这是一种在其他情况下改善多学科护理的有效方法。
