viernes, 3 de agosto de 2012

National Quality Measures Clearinghouse | Melanoma: is the surgeon who performs sentinel lymph node biopsy (SLNB) or lymph node dissection (LND) for melanoma certified by the American Board of Surgery or equivalent board or international association?

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National Quality Measures Clearinghouse | Melanoma: is the surgeon who performs sentinel lymph node biopsy (SLNB) or lymph node dissection (LND) for melanoma certified by the American Board of Surgery or equivalent board or international association?

Title

Melanoma: is the surgeon who performs sentinel lymph node biopsy (SLNB) or lymph node dissection (LND) for melanoma certified by the American Board of Surgery or equivalent board or international association?

Source(s)

Bilimoria KY, Raval MV, Bentrem DJ, Wayne JD, Balch CM, Ko CY. National assessment of melanoma care using formally developed quality indicators. J Clin Oncol 2009 Nov 10;27(32):5445-51. PubMed External Web Site Policy

J Clin Oncol. 2009 Nov 10;27(32):5445-51. Epub 2009 Oct 13.

National assessment of melanoma care using formally developed quality indicators.

Bilimoria KY, Raval MV, Bentrem DJ, Wayne JD, Balch CM, Ko CY.

Source

Department of Surgery, American College Surgeons, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3211, USA. kbilimoria@facs.org

Erratum in

J Clin Oncol. 2010 Feb 1;28(4):708.

Abstract

PURPOSE:

There is considerable variation in the quality of cancer care delivered in the United States. Assessing care by using quality indicators could help decrease this variability. The objectives of this study were to formally develop valid quality indicators for melanoma and to assess hospital-level adherence with these measures in the United States.

METHODS:

Quality indicators were identified from available literature, consensus guidelines, and melanoma experts. Thirteen experts ranked potential measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology. Adherence with individual valid indicators and a composite measure of all indicators were assessed at 1,249 Commission on Cancer hospitals by using the National Cancer Data Base (NCDB; 2004 through 2005).

RESULTS:

Of 55 proposed quality indicators, 26 measures (47%) were rated as valid. These indicators assessed structure (n = 1), process (n = 24), and outcome (n = 1). Of the 26 measures, 10 are readily assessable by using cancer registry data. Adherence with valid indicators ranged from 11.8% to 96.5% at the patient level and 3.7% to 83.0% at the hospital level. (Adherence required that >OR= 90% of patients at a hospital receive concordant care.) Most hospitals were adherent with 50% or fewer of the individual indicators (median composite score, five; interquartile range, four to seven). Adherence was higher for diagnosis and staging measures and was lower for treatment indicators.

CONCLUSION:

There is considerable variation in the quality of melanoma care in the United States. By using these formally developed quality indicators, hospitals can assess their adherence with current melanoma care guidelines through feedback mechanisms from the NCDB and can better direct quality improvement efforts.