肿瘤住院患者治疗质量控制与分析:来自北京市9家医院的访谈与病历调查

Quality Control and Analysis of Treatment for Hospitalized Cancer Patients: An Interview and Medical Records Study from Nine Hospitals in Beijing

  • 摘要: 目的 分析北京市当前肿瘤住院患者的治疗质量, 识别治疗实践中存在的主要问题并提出改进意见, 为完善我国癌症防治体系提供参考依据。 方法 选取北京市9 家医院作为检查对象,通过专家现场访谈及病历抽查,采用《北京市肿瘤诊疗质控检查表》对医院 2023 年 1—10 月抗肿瘤治疗过程中的硬件、管理、药物治疗、放射治疗、手术治疗等方面进行评估,分析肿瘤治疗中存在的问题。 结果 在接受检查的 9 家医院中, 2 家(22.2%)配备层流室, 3 家(33.3%)建有静脉药物配置中心。制度管理方面,7 家(77.8%)抗肿瘤药物处方权限管理规范, 8 家(88.9%)应急预案完备, 5 家(55.6%)有肿瘤专科药师。抗肿瘤药物治疗方面,病理诊断支持(97.6%)、治疗前常规检查(96.3%)、出院小结(95.1%)、 不良反应评价处理得当率(92.7%)和入院记录(91.5%)完整率较高。治疗前 TNM 分期准确率(70.7%)及后续疗效评价完整率(76.9%)尚需加强。肿瘤专科在 TNM 分期准确率(86.0%比 46.9%, P<001)及知情同意书完整度(100%比68.8%, P<001)、 药物适应证评价完整率(96.0%比 78.1%, P=0.025)、入院病史记录完整率(98.0%比 81.3%, P=0.008)、药物剂量合理率(96.0%比 75.0%, P=0.005)、药物输注时间合理率(100%比 62.5%, P<001)和药物输注顺序合理率(100%比 87.5%,P=0.010)方面均明显优于非肿瘤专科。放射治疗方面,整体质量较高,但后续疗效评价恰当率仅为 39.3%,需进一步加强。手术治疗方面,术前病理诊断支持率(78.1%)、TNM 分期准确率(37.5%)均较低,存在术前评估不全及多学科讨论缺失问题。 结论 我国肿瘤治疗质量仍有较大提升空间,建议未来通过规范肿瘤分期评估流程、加强对非肿瘤专业科室的准入考核、推动多学科诊疗模式实施、建立多部门联合管理模式,对肿瘤诊疗质量相关指标进行持续监测,以促进肿瘤诊疗质量持续改进。

     

    Abstract: Objective To analyze the current quality of treatment for hospitalized cancer patients in Beijing, identify major issues in treatment practices, and propose improvements, providing a reference for enhancing China's cancer prevention and treatment system. Methods Nine hospitals in Beijing were selected for examination. Expert on-site interviews and medical record sampling were conducted. The Beijing Cancer Diagnosis and Treatment Quality Control Checklist was used to assess various aspects of anti-cancer treatment at these hospitals. Issues in hardware, management, anti-cancer drug therapy, radiation therapy, and surgical treatment during cancer treatment from January to October 2023 were analyzed. Results Among the nine hospitals, 2 (22.2%) were equipped with laminar flow rooms, and 3 (33.3%) had intravenous drug preparation centers. In terms of institutional management, 7 hospitals (77.8%) had standardized anti-cancer drug prescription authority management, 8 (88.9%) had complete emergency plans, and 5 (55.6%) had oncology specialist pharmacists. Regarding anti-cancer drug therapy, the areas with higher completion rates included pathology diagnosis support (97.6%), routine pre-treatment examinations (96.3%), discharge summaries (95.1%), adverse reaction evaluation(92.7%), and admission records (91.5%). However, the accuracy of tumor staging before treatment (70.7%) and the evaluation of therapeutic efficacy after drug treatment (76.9%) need improvement. The oncology specialty significantly outperformed the non-oncology specialty in terms of the accuracy rate of TNM staging (86.0% vs. 46.9%, P< 0.001), the completeness of informed consent forms (100% vs. 68.8%, P< 0.001), the completeness of drug indication evaluation (96.0% vs. 78.1%, P= 0.025), the completeness of admission medical history records (98.0% vs. 81.3%, P= 0.008), the rationality of drug dosage (96.0% vs. 75.0%, P= 0.005), the rationality of drug infusion time (100% vs. 62.5%, P< 0.001), and the rationality of the order of drug infusion (100% vs. 87.5%, P= 0.010). While the quality of radiation therapy was high, the subsequent evaluation of therapeutic efficacy (39.3%) requires enhancement. In surgical treatment, the preoperative pathology diagnosis support rate (78.1%) and the accuracy of tumor staging (37.5%) were relatively low, indicating issues with incomplete preoperative evaluation and the absence of multidisciplinary discussions. Conclusion There remains significant room for improvement in the quality of cancer treatment in China. It is recommended to standardize tumor staging assessment processes, strengthen entry assessments for non-oncology departments, promote the implementation of multidisciplinary treatment models, and establish a multi-department collaborative management model. Continuous monitoring of cancer diagnosis and treatment quality indicators is essential to promote ongoing improvements in cancer treatment quality.

     

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