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实施临床路径对浸润性乳腺癌治疗质量改善的影响研究

发表时间:2016-12-15  浏览量:1348  下载量:229
全部作者: 包含,苏少飞,王心雨,刘美娜
作者单位: 哈尔滨医科大学公共卫生学院
摘 要: 目的:比较浸润性乳腺癌临床路径实施前后治疗质量评价指标的依从率,分析临床路径的实施对乳腺癌治疗质量的影响。方法:收集肿瘤专科医院临床路径实施前后的病例资料并分为对照组和干预组,利用单变量分析比较两组的基线特征,利用多变量Logistic回归调整组间不均衡的基线特征,比较临床路径实施前后治疗质量评价指标的依从率,利用Wilcoxon秩和检验比较总住院日和术前住院日。结果:本研究共调查了578例浸润性乳腺癌患者,对照组283例、干预组295例。患者年龄、病理分期、组织学分级及人类表皮生长因子受体-2(human epidermal growth factor receptor-2,Her-2)状态在干预前后的差别有统计学意义;调整基线特征后,术前空芯针穿刺活检、前哨淋巴结活检(sentinel lymph nodes biopsy,SLNB)、病理报告记录肿瘤激素受体状态在实施临床路径前后的依从率差别有统计学意义;临床路径实施后平均住院日由9 d减少至8 d,术前平均住院日有所增加。结论:临床路径的实施在术前空芯针穿刺活检、SLNB、病理报告记录肿瘤激素受体状态等方面缩小了乳腺癌临床实践与基于证据的标准治疗的差距,对浸润性乳腺癌治疗质量的改善有积极作用。
关 键 词: 流行病学;乳腺癌;临床路径;治疗质量
Title: Study of the impact of clinical pathway implementation on the quality of care for invasive breast cancer
Author: BAO Han, SU Shaofei, WANG Xinyu, LIU Meina
Organization: Public Health College, Harbin Mendical University
Abstract: Objective: By comparing the concordance rates of quality indicators before and after the implementation of clinical pathway on invasive breast cancer, the study aimed to evaluate the effectiveness of clinical pathway on the quality of breast cancer care. Methods: The medical records of patients diagnosed as invasive breast cancer before and after the implementation of clinical pathway were extracted as the control group and the intervention group, respectively. Baseline characteristics between two groups were compared by using univariate analysis. Concordance rates of quality indicators before and after the implementation of clinical pathway were compared by using multivariate Logistic regression adjusting for relevant imbalanced baseline characteristics. Comparisons of the total and preoperative length of hospital stay between two groups were conducted by using Wilcoxon rank sum test. Results: A total of 578 invasive breast cancer patients were enrolled in this study with 283 in the control group and 295 in the intervention group. There were statistically significant differences in age, stage, histological grade and human epidermal growth factor receptor-2 (Her-2) status between the patients in two groups. After adjusting imbalanced baseline characteristics, we observed a statistically significant improvement in the concordance rates of indicators including fine-needle aspiration, sentinel lymph nodes biopsy (SLNB), and the proportion of patients who had their tumor hormone receptor status documented in their pathology report. The mean length of hospital stay was significantly reduced from 9 days to 8 days and the mean preoperative stay increased. Conclusion: The implementation of clinical pathway for breast cancer had bridged the gap between clinical practice and evidence-based therapy in areas like fine-needle aspiration, SLNB and tumor hormone receptor status documentation. It had a positive effect on the improvement of quality of care for invasive breast cancer.
Key words: epidemiology; breast cancer; clinical pathway; quality of care
发表期数: 2016年12月第23期
引用格式: 包含,苏少飞,王心雨,等. 实施临床路径对浸润性乳腺癌治疗质量改善的影响研究[J]. 中国科技论文在线精品论文,2016,9(23):2460-2464.
 
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