A Study of the factors related to Patient-Level Compliance with Breast Cancer Core Measures Indicators and Its Relationship with Patient Survival

• Main Authors: Shin-Yun Tsai, 蔡欣芸
• Other Authors: Kuo-Piao Chung
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/30582210329130014669

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 96 === Background: The Bureau of Health Promotion (BPH) in Taiwan started to collect six cancer treatment data included breast cancer, cervical, colorectal, oral, lung, and liver cancer at Taiwan Cancer Data Base (TCDB) from hospitals since year 2003. In order to improve care quality and benchmark among cancer care hospitals, the BHP supported a project from year 2004 to 2006 for quality improvement mechanism that included establishing six cancer core measure sets by research team of College of Public Health (It was the pre-phase of the Center for Health Insurance Research), National Taiwan University. There are more breast cancer researches than other kinds of cancers. However, most researches using quality measures are population-based to investigate the proportion of received eligibility care over total number of patients. However, it can’t point out each case whether he/she gets the eligible care or not. There are limited searches to discuss the relationship between the core measure set compliance rate with patient survival. This study attempt to using breast cancer core measure set to realize the care service offered at present, to explore the factors of patient-level compliance, and to explore the relationship between core measure compliance rate and patient survival. Method: Using TCDB and NHI database to collect patients’ demographic and clinical characteristics, hospital characteristics and volume, as well as the eligibility and compliance numbers of patients among 12 breast cancer core measures included pre-treatment (2), treatment (9) and follow-up (1) items. This study performed a retrospective cohort study of all 10,579 breast cancer patients registered from 29 hospitals in Taiwan between 2002 and 2004, and connected to these cases survival data between 2002 and 2005. To complement the population-based measurement, this study use case-based approach to find out the care services each patient received in the whole care process from pretreatment to follow-up. The log-rank test and chi-square are used to compare the survival contribution and compliance rate. The regression model is used to predict the factors of the core measure set compliance at each patient. To adjust for potentially confounding variables, this study used a Cox proportional hazards model as multivariate analysis to examine relationships between patient-level compliance and survival. Result: (I) Hospital characteristics: These cases are registered from 17 medical centers and 12 regional hospitals, and most registered hospitals are located in Taipei metropolitan (12, 41.4%). Among this hospitals, the medium surgery volume per year is 95(range from 9 to 476); the medium radiation therapy volume per year is 35(range from 3 to 244); the chemotherapy volume per year is 68(range from 1 to 382); the mean hormone therapy volume if 81(range from 14 to 280). (II)Patient characteristics: most patients’ diagnosed age is between 40 to 50, with a mean age of 51; most of them received cancer care in one hospital after diagnosed and most of these hospitals breast cancer ambulatory and emergency volume is between 1000 to 2000 cases per month. During the research period, the mean survival follow-up time is 25.4 month and the survival rate is 92.7% (n=9810) in the end of 2005. (III)Clinical characteristics: Most patients are stage II (43.3%); most diagnostic confirmation used positive histology or cytology (99.6%); most tumor size under 2cm (n=4149, 39.2%); most node negative is more than positive; invasive carcinoma is more than carcinoma in situ; the most treatment type is surgery, followed by chemotherapy, hormone therapy and radiation therapy. The core measure items mean eligibility rate is 52.9% and the mean compliance rate is 67.4%. The core measure set mean compliance rate is 45.37% according to pathology staging. Most stage I patient compliance rate is 50% to 75%; most Stage0, II, III patient compliance rate is 25% to 50%; most stage IV patient compliance rate is under 25%. (IV) The factors related to patient-level compliance rate included diagnosed age, the number of hospital patient visits, pathology stage, tumor size, node involvement, tumor behavior, hospital accreditation level, location, ambulatory and emergency volume, as well as the volume of surgery, radiation therapy, chemotherapy, and hormone therapy. (V) The factors related to patient survival are diagnosed age, pathology stage, tumor size, node involvement, and core measure set compliance. The relationship between hospital characteristics and patient survival is not significant in this study. Conclusion: Breast cancer core measure set can predict patient survival that the higher the patient-level compliance rate, the better the survival. This study combines population-based and case-based measurement to explore the breast cancer care at present and find the well performed items needed to maintain and deficiency items needed to be improved. It also finds some core measure items are related to the patient survival. The health authorities and providers may follow these recommendations according to the results and the patient survival will be enhanced in the future.