利用数据改善医疗保健：以胰腺癌中胰酶替代治疗为例。

Using Data to Improve Healthcare: A Case Study of Pancreatic Enzyme Replacement in Pancreatic Cancer.

机构信息

Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.

Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

出版信息

Semin Oncol Nurs. 2024 Oct;40(5):151688. doi: 10.1016/j.soncn.2024.151688. Epub 2024 Jul 22.

DOI:10.1016/j.soncn.2024.151688

PMID:39043534

Abstract

OBJECTIVES

In the UK, guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. In 2023, we published a national audit of PERT which showed suboptimal prescribing and wide regional variation in England. The aim of this manuscript was to describe how we used the PERT audit to drive improvements in healthcare.

METHODS

Building on the PERT audit, we deployed an online dashboard which will deliver ongoing updates of the PERT audit. We developed a collaborative intervention with cancer nurse specialists (CNS) to improve care delivered to people with pancreatic cancer. The intervention called Creating a natiOnAL CNS pancrEatic cancer network to Standardise and improve CarE (COALESCE) will use the dashboard to evaluate improvements in prescribing of PERT.

RESULTS

We demonstrated how large databases of electronic healthcare records (EHRs) can be used to improve cancer care. The PERT audit was implemented into a dashboard for tracking the progress of COALESCE. We will measure improvements in PERT prescribing as the intervention with CNS progresses.

CONCLUSIONS

Improving healthcare is an ongoing and iterative process. By implementing the PERT dashboard, we created a resource-efficient, automated evaluation method enabling COALESCE to deliver a sustainable change. National-scale databases of EHRs enable rapid cycles of audits, providing regular feedback to interventions, working systematically to deliver change. Here, the focus is on pancreatic cancer. However, this methodology is transferable to other areas of healthcare.

IMPLICATIONS FOR NURSING PRACTICE

Nurses play a key role in collecting good quality data which are needed in clinical audits to identify shortcomings in healthcare. Nurse-driven interventions can be designed to improve healthcare. In this study, we capitalize on the unique role of CNS coordinating care for every patient with cancer. COALESCE is the first national collaborative study which uses CNS as researchers and change agents.

摘要

目的

在英国，指南建议所有无法手术的胰腺癌患者使用胰酶替代疗法（PERT）。2023 年，我们发布了一项关于 PERT 的国家审计，结果显示英格兰的处方开具情况并不理想，且存在广泛的地区差异。本文旨在描述我们如何利用 PERT 审计来改善医疗保健。

方法

在 PERT 审计的基础上，我们部署了一个在线仪表板，该仪表板将提供 PERT 审计的持续更新。我们与癌症护士专家（CNS）合作开展了一项合作干预措施，以改善胰腺癌患者的护理。这项名为“创建国家 CNS 胰腺癌网络以标准化和改善护理（COALESCE）”的干预措施将使用仪表板来评估 PERT 处方的改进情况。

结果

我们展示了如何使用大型电子病历（EHR）数据库来改善癌症护理。将 PERT 审计纳入 COALESCE 的仪表板中，以跟踪其进展。随着 CNS 干预的进展，我们将衡量 PERT 处方的改进情况。

结论

改善医疗保健是一个持续和迭代的过程。通过实施 PERT 仪表板，我们创建了一种资源高效、自动化的评估方法，使 COALESCE 能够实现可持续的变革。EHR 的国家规模数据库使审计能够快速循环进行，为干预措施提供定期反馈，有系统地推动变革。在这里，重点是胰腺癌。然而，这种方法可以推广到医疗保健的其他领域。