NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia.
BMJ Open. 2024 Feb 14;14(2):e074399. doi: 10.1136/bmjopen-2023-074399.
Lung cancer continues to be the most common cause of cancer-related death and the leading cause of morbidity and burden of disease across Australia. There is an ongoing need to identify and reduce unwarranted clinical variation that may contribute to these poor outcomes for patients with lung cancer. An Australian national strategy acknowledges clinical quality outcome data as a critical component of a continuously improving healthcare system but there is a need to ensure clinical quality indicators adequately measure evidence-based contemporary care, including novel and emerging treatments. This study aimed to develop a suite of lung cancer-specific, evidence-based, clinically acceptable quality indicators to measure quality of care and outcomes, and an associated comparative feedback dashboard to provide performance data to clinicians and hospital administrators.
A multistage modified Delphi process was undertaken with a Clinical Advisory Group of multidisciplinary lung cancer specialists, with patient representation, to update and prioritise potential indicators of lung cancer care derived from a targeted review of published literature and reports from national and international lung cancer quality registries. Quality indicators were piloted and evaluated with multidisciplinary teams in a retrospective observational cohort study using clinical audit data from the Embedding Research (and Evidence) in Cancer Healthcare Program, a prospective clinical cohort of over 2000 patients with lung cancer diagnosed from May 2016 to October 2021.
Six tertiary specialist cancer centres in metropolitan and regional New South Wales, Australia.
From an initial 37 potential quality indicators, a final set of 10 indicators spanning diagnostic, treatment, quality of life and survival domains was agreed.
These indicators build on and update previously available measures of lung cancer care and outcomes in use by national and international lung cancer clinical quality registries which, to our knowledge, have not been recently updated to reflect the changing lung cancer treatment paradigm.
肺癌仍然是癌症相关死亡的最常见原因，也是澳大利亚发病率和疾病负担的主要原因。需要不断识别和减少可能导致肺癌患者不良结局的不必要的临床差异。澳大利亚国家战略承认临床质量结果数据是不断改进医疗保健系统的关键组成部分，但需要确保临床质量指标充分衡量基于证据的现代护理，包括新出现的治疗方法。本研究旨在制定一套肺癌特异性、基于证据、临床可接受的质量指标，以衡量护理质量和结果，并提供相关的比较反馈仪表板，为临床医生和医院管理人员提供绩效数据。
采用多阶段改良 Delphi 流程，由多学科肺癌专家临床咨询小组与患者代表合作，更新和优先考虑从已发表文献和国家及国际肺癌质量登记处的报告中针对肺癌护理的潜在指标。质量指标在一项回顾性观察队列研究中进行了试点和评估，该研究使用了从 2016 年 5 月至 2021 年 10 月期间纳入的超过 2000 例肺癌患者的临床审计数据，这些患者来自于“将研究（和证据）嵌入癌症医疗保健计划”（Embedding Research (and Evidence) in Cancer Healthcare Program）前瞻性临床队列。
澳大利亚新南威尔士州大都市和地区的六家三级癌症中心。
从最初的 37 个潜在质量指标中，确定了最终的 10 个指标，涵盖诊断、治疗、生活质量和生存领域。
这些指标建立在并更新了以前可用的全国和国际肺癌临床质量登记处使用的肺癌护理和结果衡量标准，据我们所知，这些标准最近没有更新以反映不断变化的肺癌治疗模式。
