West J G, Sutherland M L, Link J S, Margileth D A
Breast Care Center, Orange, CA 92668, USA.
West J Med. 1997 Apr;166(4):248-52.
The transition to managed care raises concerns about the resulting quality of care. The report card, a publicly released, standardized report on quality, has received widespread acceptance as a method to evaluate physician performance. Current report cards provide insufficient information to allow purchasers of health care to assess accurately the performance of professionals who provide breast care. To overcome these limitations, we propose an expanded report card on breast cancer care. Mammographers and general surgeons would assess an independent series of at least 100 consecutive cases of newly diagnosed breast cancer. Mammographers would determine the percentage of invasive cancers < 15 mm detected on screening mammograms in asymptomatic women aged 50 to 74 years. Surgeons would determine the percentage of combined stages 0 and 1 breast cancers detected and the percentage of patients receiving breast-conserving surgical therapy. Performance targets are set at 60% for invasive cancers < 15 mm detected on screening mammography, 60% for combined stage 0 and 1 breast cancers, and 50% for patients receiving breast-conserving therapy.
向管理式医疗的转变引发了人们对由此产生的医疗质量的担忧。成绩单是一份公开发布的、关于质量的标准化报告，作为评估医生表现的一种方法已得到广泛认可。目前的成绩单提供的信息不足，无法让医疗保健购买者准确评估提供乳腺护理的专业人员的表现。为克服这些局限性，我们提议编制一份关于乳腺癌护理的扩展成绩单。乳腺造影技师和普通外科医生将评估至少100例连续新诊断乳腺癌的独立病例系列。乳腺造影技师将确定在50至74岁无症状女性的筛查乳腺造影片上检测到的浸润性癌＜15mm的百分比。外科医生将确定检测到的0期和1期乳腺癌联合分期的百分比以及接受保乳手术治疗的患者百分比。筛查乳腺造影片上检测到的浸润性癌＜15mm的性能目标设定为60%，0期和1期乳腺癌联合分期为60%，接受保乳治疗的患者为50%。
