乳癌試辦計畫品質指標在第三期乳癌病人治療之效果評估
Date Issued
2006
Date
2006
Author(s)
Shih, Chiang-Ching
Abstract
The quality indicators of pay-for-performance for breast cancer are originated from the evidence-based literature review, formed through expert meeting and tested by the data of National Health Insurance Bureau and implemented by National Health Insurance Bureau to assure the quality of care of breast cancer patients and be the fundamental measurement of pay-for-performance. The content consisted of three parts: structure, process and outcome. The purpose of this study is to evaluate and analyze the clinical outcomes and medical expenses of stage III breast cancer patients in one cancer center by the quality indicators mentioned above.
In this study, we collect data retrospectively from clinical protocol office and financial department of one cancer center. The major issues to be analyzed are: 1. epidemiological data and time to event, 2. the adherence rates of each quality indicators in each year, 3. the relationship between adherence rate and outcome, 4. the relationship among the adherence rate, outcome and expense, 5. the suggestion proposed for future research, hospital administration and policy makers based on the findings of this study.
The major findings from this 208-patient study are:
1. The average age of disease acquisition is 49 years old and 67 patients had recurrence and 51 patients expired after recurrence.
2. The average adherence rates of each quality indicators are high (81% to 99%) but the rates of total adherence of diagnosis and treatment indicators are lower (66% to 81%). There is significant improvement in the rates of total adherence after the implementation of treatment guideline in 1997(from 56-74% to 75-87%).
3. The total adherence of treatment indicators has the most significant impact on survival rate and disease-free survival rate, no matter before or after 1997.
4. The average expanse of recurrence patients is almost two times as much as those non-recurrence patients (856,818 vs. 449,474 NTD). The total average expanse (including risk of recurrence) of those patients with total treatment adherence is 627,619 NTD and 188,178 NTD higher than those without total treatment adherence. But the differences of recurrence rates and mortality rates between these 2 groups are 24% and 33%.
5. Because of the significant relationship between the process and outcome quality indicators, the importance of total treatment adherence, and the integrity and continuity of cancer treatment, the author suggests that it is important to have a functional team and the system for monitoring the adherence of the quality indicators. In this way, the improvement of outcome and quality of care can be assured. The young age, and their expected long-term survival (estimated median survival year 20 years) of stage III breast cancer patients make total treatment adherence worthwhile, although the average expense is higher.
Subjects
論質計酬
醫療品質
品質指標
完全執行
Pay-for-Performance
Quality of Care
Quality Indicator
Total Adherence
SDGs
Type
other
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