Department of Medicine, Palliative Care Medicine Section, University of Virginia Health System, Charlottesville, VA.
Department of Neurology, Division of Neuro-Oncology, University of Virginia Health System, Charlottesville, VA.
JCO Oncol Pract. 2021 Mar;17(3):e397-e405. doi: 10.1200/OP.20.00233. Epub 2020 Aug 11.
High-value and high-quality health care requires outcome measurements to inform treatment decisions, but, to our knowledge, no standardized measurements exist to evaluate brain metastases (BMs) care. We propose a set of measurements and report on their implementation in the care of patients with BMs.
On the basis of a stakeholders' needs assessment and review of the literature, we identified outcome and process measurements to assess the care of patients with BMs according to treatment modality. Retrospectively, we applied these indicators of care to all patients diagnosed and treated at our institution over 2 years.
We ascertained 5 outcome and 6 process measurements of relevance in the care of BMs. When applied to 209 patients (89.7%) who received cancer treatment, 77% were alive > 90 days after diagnosis. The proportion alive at 90 days after surgery, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS) was 82%, 59%, and 81%, respectively. Other performance measurements included 30-day postoperative readmission rate (6%), SRS within 30 days of surgery (79%), use of memantine with WBRT (41%), advance directives within 6 months of diagnosis (53%), and palliative care consultation for patients with poor prognosis or receiving WBRT (45%). Measurements for the 24 patients (10.3%) receiving best supportive care were advance directives documentation (67%) and referral to palliative or hospice care (83%).
We propose a set of measurements to apprise quality improvement efforts, inform treatment decision-making, and to use in evaluation of the performance of interdisciplinary BMs programs. Their refinement can potentially enhance the quality and value of care delivered to patients with BMs.
高质量和高价值的医疗保健需要使用结果测量来为治疗决策提供信息，但据我们所知，目前还没有用于评估脑转移瘤（BMs）治疗的标准化测量方法。我们提出了一套测量方法，并报告了它们在 BMs 患者治疗中的实施情况。
基于利益相关者的需求评估和文献回顾，我们确定了根据治疗方式评估 BMs 患者治疗的结果和过程测量方法。回顾性地，我们将这些护理指标应用于我们机构在两年内诊断和治疗的所有患者。
我们确定了与 BMs 护理相关的 5 项结果和 6 项过程测量方法。当应用于接受癌症治疗的 209 名患者（89.7%）时，77%的患者在诊断后 90 天以上仍存活。手术后、全脑放疗（WBRT）和立体定向放射外科（SRS）后 90 天存活的比例分别为 82%、59%和 81%。其他绩效测量包括 30 天术后再入院率（6%）、SRS 在手术后 30 天内（79%）、WBRT 中使用美金刚（41%）、诊断后 6 个月内制定预嘱（53%）以及对预后不良或接受 WBRT 的患者进行姑息治疗咨询（45%）。对接受最佳支持治疗的 24 名患者（10.3%）进行的测量包括预嘱文件（67%）和转诊至姑息治疗或临终关怀（83%）。
我们提出了一套测量方法，以评估质量改进工作，为治疗决策提供信息，并用于评估多学科 BMs 项目的绩效。对其进行改进可能会提高 BMs 患者治疗的质量和价值。
