Robinson Tyler P, Kaiser Kristen, Lark Meghan, Ruedinger Brian, Robb Bruce W, Morgan Teryn, Park Seho, Schleyer Titus K L, Haggstrom David A, Mohanty Sanjay
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Am J Surg. 2025 Feb;240:116114. doi: 10.1016/j.amjsurg.2024.116114. Epub 2024 Nov 28.
The National Comprehensive Cancer Care Network (NCCN) provides recommendations for patients with colorectal cancer. Concordance with evidence-based guidelines improves outcomes. Our objectives were to 1) examine rates of guideline non-concordance in a large vertically integrated health system; 2) examine factors associated with non-concordant care, and 3) identify geographical patterns of non-concordant care.
Colorectal cancer patients were identified from a single-state 16 hospital health-system cancer registry diagnosed between 2011 and 2021. We defined major (MAJ) and minor (MIN) quality indicators of guideline-concordance based on NCCN guidelines. Regression methods were used to identify predictors of major quality criteria non-concordance. County-level mapping was used to identify geographical locations of the highest rates of non-concordance.
Overall, 2324 patients with colon and rectal cancer were analyzed. There was a complete guideline concordance (an absence of guideline non-concordance) rate of 24.7% (n = 573), MIN only guideline non-concordance rate of 63.3% (n = 1471), and MAJ non-concordance rate of 12.4% (n = 280). Predictors of MAJ non-concordance for colon cancer were stage, >1 Charleson-Deyo Score, >60 days from diagnosis to treatment, and >1 hospital network used for care. Predictors of MAJ non-concordance for rectal cancer were >60 days from diagnosis to treatment, and >1 facility used for care. Marion county had the highest rates of non-concordance for colon and rectal cancer.
The majority of colon and rectal cancer patients in a large health system received guideline concordant major quality indicators, however 12% of patients do not. An identifiable geographical location with the highest rates of non-concordance and its associated factors serves as a target for future quality improvement.
美国国立综合癌症网络（NCCN）为结直肠癌患者提供相关建议。遵循循证指南可改善治疗结果。我们的目标是：1）在一个大型垂直整合医疗系统中检查指南不遵循率；2）研究与不遵循治疗相关的因素；3）确定不遵循治疗的地理模式。
从一个单州16家医院的医疗系统癌症登记处中识别出2011年至2021年间诊断的结直肠癌患者。我们根据NCCN指南定义了指南遵循的主要（MAJ）和次要（MIN）质量指标。采用回归方法确定主要质量标准不遵循的预测因素。利用县级地图确定不遵循率最高的地理位置。
总体而言，共分析了2324例结肠癌和直肠癌患者。完全遵循指南（不存在指南不遵循情况）的比例为24.7%（n = 573），仅存在次要不遵循情况的比例为63.3%（n = 1471），主要不遵循情况的比例为12.4%（n = 280）。结肠癌主要不遵循的预测因素为分期、Charlson-Deyo评分>1、从诊断到治疗的时间>60天以及接受治疗所使用的医院网络>1个。直肠癌主要不遵循的预测因素为从诊断到治疗的时间>60天以及接受治疗所使用的机构>1个。马里恩县的结肠癌和直肠癌不遵循率最高。
在一个大型医疗系统中，大多数结肠癌和直肠癌患者接受了符合指南的主要质量指标治疗，然而仍有12%的患者未达到。确定不遵循率最高的地理位置及其相关因素可作为未来质量改进的目标。
