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参保人群早期乳腺癌的医疗护理衡量标准。

Measuring standards of care for early breast cancer in an insured population.

作者信息

Hillner B E, McDonald M K, Penberthy L, Desch C E, Smith T J, Maddux P, Glasheen W P, Retchin S M

机构信息

Department of Internal Medicine, Medical College of Virginia, Richmond 23298, USA.

出版信息

J Clin Oncol. 1997 Apr;15(4):1401-8. doi: 10.1200/JCO.1997.15.4.1401.

Abstract

PURPOSE

To demonstrate the use of a combined data base to evaluate the care for local/regional invasive breast cancer in a large insured population of women aged less than 64 years.

PATIENTS AND METHODS

We linked the procedural and hospital claims from Blue Cross Blue Shield (BCBS) of Virginia with clinical stage data from the Virginia Cancer Registry (VCR) from 1989 to 1991. A total of 918 women were assessed with a median age of 50 years; 68% had tumors less than 2 cm, 30% had positive axillary nodes, and 68% were assessed as having local summary stage. A quality-of-care "report card" was used based on standards of care from international Consensus Conferences.

RESULTS

Eight percent had a mastectomy as the initial biopsy procedure. Sixty-nine percent of women ultimately underwent mastectomy. Of those women who underwent lumpectomy, 86% had subsequent radiation. Within 3 months of diagnosis, 43% had a bone scan and 20% a computed tomography (CT) scan. Of women with positive axillary lymph nodes, 83% aged less than 51 years and 52% aged 51 to 64 years received chemotherapy. Fifty-six percent of all women had claims from a medical oncologist. Of women having a total mastectomy, 27% had claims from a plastic surgeon. Sixty-six percent to 76% of women had a mammogram, 24% a bone scan, and 14% a CT scan in the 0-18 and 18-36 month intervals following primary treatment.

CONCLUSION

This study confirms the feasibility of linking sources of data that provide complementary information needed to develop measurements regarding standards of quality and efficiency of oncologic care. This report should serve as an initial benchmark while we await reports from other populations to define the best practice.

摘要

目的

展示如何使用联合数据库来评估一大群年龄小于64岁的参保女性中局部/区域浸润性乳腺癌的治疗情况。

患者与方法

我们将弗吉尼亚蓝十字蓝盾公司(BCBS)的手术和住院理赔数据与弗吉尼亚癌症登记处(VCR)1989年至1991年的临床分期数据相链接。总共评估了918名女性,中位年龄为50岁;68%的患者肿瘤小于2厘米,30%的患者腋窝淋巴结阳性,68%的患者被评估为处于局部总结分期。根据国际共识会议的护理标准使用了一份护理质量“成绩单”。

结果

8%的患者最初活检程序为乳房切除术。最终69%的女性接受了乳房切除术。在接受保乳手术的女性中,86%随后接受了放疗。在诊断后的3个月内,43%的患者进行了骨扫描,20%的患者进行了计算机断层扫描(CT)。腋窝淋巴结阳性的女性中,年龄小于51岁的83%和年龄在51至64岁的52%接受了化疗。所有女性中有56%有来自医学肿瘤学家的理赔记录。在接受全乳房切除术的女性中,27%有来自整形外科医生的理赔记录。在初次治疗后的0 - 18个月和18 - 36个月期间,66%至76%的女性进行了乳房X线摄影,24%进行了骨扫描,14%进行了CT扫描。

结论

本研究证实了将提供制定肿瘤护理质量和效率标准所需补充信息的数据源相链接的可行性。在我们等待其他人群的报告以确定最佳实践时,本报告应作为初步基准。

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