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胶质瘤手术中的经典及疾病特异性质量指标——制定质量检查表以提高胶质瘤患者的治疗质量

Classical and disease-specific quality indicators in glioma surgery-Development of a quality checklist to improve treatment quality in glioma patients.

作者信息

Menke Christiane, Lohmann Sebastian, Baehr Andrea, Grauer Oliver, Holling Markus, Brokinkel Benjamin, Schwake Michael, Stummer Walter, Schipmann Stephanie

机构信息

Department of Neurosurgery, University Hospital Münster, Münster, Germany.

Department of Radiation Oncology, University Hospital Münster, Münster, Germany.

出版信息

Neurooncol Pract. 2021 Oct 11;9(1):59-67. doi: 10.1093/nop/npab063. eCollection 2022 Feb.

Abstract

BACKGROUND

There is a pressing demand for more accurate, disease-specific quality measures in the field of neurosurgery. Aiming at most adequately measuring and reflecting the quality of glioma therapy, we developed a novel quality indicator bundle in form of a checklist for all patients that are treated operatively for glioma.

METHODS

On the basis of possible glioma-specific quality indicators retrieved from the literature and quality guidelines, a multidisciplinary team developed a checklist containing 13 patient-need-specific outcome measures. Subsequently, the checklist was prospectively applied to a total of 78 patients compared with a control group consisting of 322 patients. A score was generated based on the maximum of quality measures achieved.

RESULTS

Significant improvements in quality after prospectively introducing the checklist were achieved for supplemental physical and occupational therapy during inpatient stay (89.4% vs 100%, = .002), consultation of a social worker during inpatient stay (64% vs 92.3%, < .001), psycho-oncological screening (14.3% vs 70.5%, < .001), psycho-oncological consultation (31.1% vs 82.1%, < .001), and consultation of the palliative care team (20% vs 40%, = .031). Overall, after introduction of the checklist one-third (n = 23) of patients reached best-practice measures in all categories, and over half of the patients (n = 44) achieved above 90% with respect to the outcome measures.

CONCLUSIONS

Aiming at ensuring comprehensive, consistent, and timely care of glioma patients, the implementation of the checklist for routine use in glioma surgery represents an efficient, easily reproducible, and powerful tool for significant improvements.

摘要

背景

神经外科领域迫切需要更准确、针对特定疾病的质量指标。为了最充分地衡量和反映胶质瘤治疗的质量,我们为所有接受手术治疗的胶质瘤患者制定了一份清单形式的新型质量指标集。

方法

基于从文献和质量指南中检索到的可能的胶质瘤特异性质量指标,一个多学科团队制定了一份包含13项针对患者需求的结局指标的清单。随后,该清单被前瞻性地应用于总共78例患者,并与由322例患者组成的对照组进行比较。根据所达到的质量指标的最大值生成一个分数。

结果

前瞻性引入清单后,住院期间补充物理和职业治疗(89.4%对100%,P = 0.002)、住院期间咨询社会工作者(64%对92.3%,P < 0.001)、心理肿瘤学筛查(14.3%对70.5%,P < 0.001)、心理肿瘤学咨询(31.1%对82.1%,P < 0.001)以及姑息治疗团队咨询(20%对40%,P = 0.031)的质量有显著改善。总体而言,引入清单后,三分之一(n = 23)的患者在所有类别中均达到最佳实践指标,超过一半的患者(n = 44)在结局指标方面达到了90%以上。

结论

为确保对胶质瘤患者进行全面、一致和及时的护理,在胶质瘤手术中常规使用该清单是一种有效、易于重复且能带来显著改善的有力工具。

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