国家胸外科标准实施：障碍、促进因素和机会。
National Thoracic Surgery Standards Implementation: Barriers, Enablers, and Opportunities.
机构信息
Canadian Partnership Against Cancer, 145 King Street West, Toronto, ON M5H 1J8, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
出版信息
Curr Oncol. 2021 Jan 13;28(1):405-416. doi: 10.3390/curroncol28010043.
BACKGROUND
Diagnosis and surgical treatment decision making for thoracic cancers is complex. Moreover, there is demonstrated variability in how each province in Canada delivers cancer care, resulting in disparities in patient outcomes. Recently, the Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based standards for the care of thoracic surgery cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants to their implementation nationally.
METHODS
This study was undertaken in two parts: (1) a national survey of thoracic surgeons to assess the perceived extent of implementation of these standards in their institution and province; and (2) formation of a focus group with a representative sample of thoracic surgeons across Canada in a qualitative study to understand the determinants of successful standards implementation.
RESULTS
37 surgeons (33% response rate) participated in the survey; 78% were from academic hospitals. The top categories of standards that were under-implemented included (a) quality assurance processes, data collection and clinician audit and feedback, and (b) ongoing regional planning and workload assessments for thoracic surgeons, and (c) pathology turnaround time target of two weeks and the use of a standardized synoptic pathology report format. Enablers, barriers, and opportunities for standards implementation contextualized the discussion within the focus group.
CONCLUSION
Study results demonstrated variation in the implementation of surgery standards across Canada and identified the determinants to the delivery of high quality surgical care. Future work will need to include the promotion and development of quality improvement strategies and effective resource allocation that is aligned with the implementation of thoracic cancer surgery standards in order to improve patient outcomes.
背景
胸部癌症的诊断和手术治疗决策较为复杂。此外，加拿大各省份在提供癌症护理方面存在明显差异，导致患者结局存在差异。最近，加拿大癌症伙伴关系组织（CPAC）发布了针对胸外科癌症患者护理的泛加基于证据的标准。本研究旨在评估这些标准在实践中的实施程度，并进一步了解其在全国范围内实施的决定因素。
方法
本研究分为两部分：（1）对胸外科医生进行全国性调查，以评估这些标准在其机构和省份的实施程度；（2）在定性研究中，成立一个由加拿大各地胸外科医生代表组成的焦点小组，以了解成功实施标准的决定因素。
结果
37 名外科医生（33%的回复率）参加了调查；78%来自学术医院。实施程度较低的标准主要包括：（a）质量保证流程、数据收集和临床医生审核和反馈；（b）胸外科医生的持续区域规划和工作量评估；以及（c）病理报告周转时间目标为两周和使用标准化的概要病理报告格式。实施标准的促进因素、障碍和机会将讨论置于焦点小组的背景下。
结论
研究结果表明，加拿大各地的手术标准实施情况存在差异，并确定了提供高质量手术护理的决定因素。未来的工作需要包括促进和制定质量改进策略，以及与胸外科癌症手术标准的实施相一致的有效资源分配，以改善患者结局。
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