摘要
目的利用joinpoint回归分析浸润性乳腺癌治疗质量变化趋势,为规范医疗实践行为、制定乳腺癌治疗质量改善措施提供参考依据。方法收集浸润性乳腺癌患者数据,基于浸润性乳腺癌治疗质量评价指标计算指标使用率,分母权重法计算综合得分;利用joinpoint回归分析医院水平浸润性乳腺癌治疗质量变化趋势。结果收集2011—2013年6家医院、2349名浸润性乳腺癌患者信息;诊断检查与腋窝淋巴结清扫相关指标使用率前3位为术前钼靶或超声检查全身(99.16%)、术后未出现并发症(98.38%)、病理报告记录肿瘤直径(98.28%),而全切术后给予放疗的使用率最低(33.33%);综合得分最高的医院为E医院(0.94),最低为F医院(0.77)。趋势分析结果显示浸润性乳腺癌治疗质量总趋势缓慢上升(MPC=0.12,P=0.003),不同医院的变化趋势略有不同,其中C医院治疗质量逐月升高(MPC=0.10,P=0.031)、D医院于2012年11月前逐月升高(MPC=0.91,P=0.001)、E医院于2011年10月前逐月下降(MPC=-2.05,P=0.004)。结论与传统回归方法相比,joinpoint回归可以更详细地评价不同时间段内浸润性乳腺癌治疗质量的趋势特征,发现治疗质量下降的关键节点,结合单指标使用率及医院综合得分,深入剖析治疗质量呈现不良趋势的原因,为规范医疗实践行为,改善治疗质量提供依据。
Objective To analyze the trend of treatment quality of invasive breast cancer using joinpoint regression,and provide reference for standardizing medical practice behavior and formulating improvement measures for breast cancer treatment quality.Methods Data of invasive breast cancer patients were collected.The utilization rate of each indicator was calculated based on the evaluation indicators of treatment quality of invasive breast cancer,and the denominator-based weight was used to obtain the comprehensive score.Joinpoint regression was used to analyze the trend of hospital-level treatment quality of invasive breast cancer.Results Data of 2349 patients from 6 hospitals from 2011 to 2013 were collected.The top three indicators with high utilization rate related to diagnostic examination of axillary lymph node dissection were preoperative molybdenum target or ultrasound(99.16%),no postoperative complications(98.38%),tumor diameter recorded in the pathology report(98.28%),and the lowest rate of the utilization of postmastectomy radiotherapy(33.33%).Hospital E has the highest composite score(0.94)and hospital F has the lowest score(0.77).Results of trend analysis showed that the trend of quality of care for invasive breast cancer has increased slowly(MPC=0.12,P=0.003),and trends of different hospitals varied,among which the quality of care of hospital C increased monthly(MPC=0.10,P=0.031),hospital D increased before November 2012(MPC=0.91,P=0.001),and hospital E declined before October 2011(MPC=-2.05,P=0.004).Conclusion Compared with the conventional regression methods,joinpoint regression could be used to evaluate the trend of quality of care for invasive breast cancer over different time periods in more detail and find the key nodes of the decrease of the treatment quality.Combined with the utilization rate of indicators and the composite score of hospitals,joinpoint regression could be used to analyze the reasons for the adverse trend of quality of care,and provide a theoretical basis for standardizing the behavior of medical practice and improving the quality of care.
作者
郭瑞泽
王超
栗景坤
魏丽
侯爽
刘美娜
Guo Ruize;Wang Chao;Li Jingkun;Wei Li;Hou Shuang;Liu Meina(Department of Health Statistics,Institute of Public Health,Harbin Medical University,Harbin 150081,China)
出处
《中国医院统计》
2022年第5期325-330,共6页
Chinese Journal of Hospital Statistics
基金
国家自然科学基金(82173614)。
