《上海市级医院口腔癌规范诊疗评价指标（试用版）》的制订

doi:10.19438/j.cjoms.2025.01.007

摘要/Abstract

摘要： 目的：为进一步加强医疗质量管理,规范临床诊疗行为,研究制订《上海市级医院口腔癌规范诊疗评价指标（试用版）》。方法：对口腔癌规范诊疗及质量评价进行系统文献检索,成立多学科工作小组进行头脑风暴,征集遴选指标。院内专家小组多轮评价筛选指标,反复修改直至达成一致意见后,提交同行专家（非院内专家小组成员）以RAM法确定指标合理性,最后制作指标索引卡片。结果：工作小组头脑风暴提出评价指标38个;专家小组进行讨论后修改再讨论,共3轮筛选至31个指标;同行专家RAM法评价有3个指标意见不一致,再经院内专家小组讨论调整,最终达成一致意见。结论：共确定31项指标,从口腔癌的诊断、外科治疗、药物治疗、放射治疗和管理5个维度评价口腔癌全生命周期诊疗质量。

关键词: 口腔癌, 规范诊疗, 诊疗质量, 评价指标

Abstract: PURPOSE: This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with oral cavity cancer in Shanghai tertiary hospitals. METHODS: A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in oral cavity cancer. A multidisciplinary working group in oral cavity cancer used selected criteria to propose indicators that were evaluated by an in-hospital expert panel. Indicators on which consensus was achieved after many discussions were then reviewed by peer review to develop a final set of indicators following RAND/UCLA appropriateness method. Finally, index cards for each indicator were developed. RESULTS: A list of 38 indicators were proposed through brainstorming at first. After three round of discussion and adjustment, there was consensus on the 31 indicators. With the RAM review of appropriateness of indicators, 28 of 31 proposed indicators achieved consensus, the remaining 3 achieved consensus after the discussion of in-hospital expert panel as the indicators for Shanghai tertiary hospitals. CONCLUSIONS: A set of 31 evidence-based and expert-supported indicators were developed for evaluating the quality of care measures for oral cavity cancer, covering diagnosis, surgical treatment, drug treatment, radiation therapy and administration.

Key words: Oral cavity cancer, Standardized diagnosis and treatment, Quality of care measures, Evaluation indicators

中图分类号:

R739.8

叶晨, 王延安, 何悦. 《上海市级医院口腔癌规范诊疗评价指标（试用版）》的制订[J]. 中国口腔颌面外科杂志, 2025, 23(1): 35-39.

YE Chen, WANG Yan-an, HE Yue. The development of multidisciplinary quality metrics for oral cavity cancer in Shanghai tertiary hospitals[J]. China J Oral Maxillofac Surg, 2025, 23(1): 35-39.

参考文献

[1] Bray F, Laversanne M, Sung H, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
[2] Han B, Zheng R, Zeng H, et al.Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.
[3] American Society of Clinical Oncology. ASCO measure methodology manual[EB/OL].[2024-08-20]. https://society.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2024-Measures-Manual.pdf.
[4] Scottish Cancer Taskforce National Cancer Quality Steering Group. Head and neck cancer clinical quality performance indicators(v4.0)[EB/OL]. (2021). https://www.healthcareimprovementscotland.org/his/idoc.ashx?docid=a51cc068-8652-4396-b04c-68b2e92514cf&version=-1.
[5] Hernández JJC, Arrula VA, álvarez YE, et al.Indicators to evaluate quality of care in head and neck cancer in Spain[J]. Clin Transl Oncol, 2024, 26(5): 1089-1097.
[6] 国家癌症中心,国家肿瘤质控中心乳腺癌专家委员会.中国乳腺癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(3): 203-208.
National Cancer Center,Breast Cancer Expert Committee of National Cancer Quality Control Cente. Quality control index for standardized diagnosis and treatment of breast cancer in China(2022 Edition)[J].Chinese Journal of Oncology, 2022, 44(3): 203-208.
[7] 国家癌症中心,国家肿瘤质控中心肺癌质控专家委员会. 中国原发性肺癌规范诊疗质量控制指标(2022版)[J]. 中华肿瘤杂志, 2022, 44(7): 594-599.
National Cancer Center,Lung Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of lung cancer in China (2022 edition)[J].Chinese Journal of Oncology, 2022, 44(7): 594-599.
[8] 国家癌症中心,国家肿瘤质控中心宫颈癌质控专家委员会.中国宫颈癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(7): 615-622.
National Cancer Center,Cervical Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of cervical cancer in China(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(7): 615-622.
[9] 国家癌症中心,国家肿瘤质控中心前列腺癌质控专家委员会.中国前列腺癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(10): 1011-1016.
National Cancer Center,Prostate Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of prostate cancer in China(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(10): 1011-1016.
[10] 国家癌症中心,国家肿瘤质控中心胰腺癌质控专家委员会. 中国胰腺癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(12): 1249-1255.
National Cancer Center,Pancreatic Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of pancreatic cancer in China (2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(12):1249-1255.
[11] 国家癌症中心,国家肿瘤质控中心结直肠癌质控专家委员会.中国原发性结直肠癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022,44(7): 623-627.
National Cancer Center, Colorectal Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of colorectal cancer in China(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(7): 623-627.
[12] 国家癌症中心,国家肿瘤质控中心肾癌质控专家委员会.中国肾癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(12): 1256-1261.
National Cancer Center, Renal Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of renal cancer in China(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(12): 1256-1261.
[13] 国家癌症中心,国家肿瘤质控中心肝癌质控专家委员会.中国肝癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(7): 600-608.
National Cancer Center, Liver Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of primary liver cancer in China(2022 edition)[J].Chinese Journal of Oncology, 2022, 44(7): 600-608.
[14] 国家癌症中心,国家肿瘤质控中心鼻咽癌质控专家委员会.中国鼻咽癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022,44(9): 895-901.
National Cancer Center, Nasopharyngeal Carcinoma Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of nasopharyngeal carcinoma in China(2022 edition)[J]. Chinese Journal of Oncology, 2022,44(9): 895-901.
[15] 国家癌症中心,国家肿瘤质控中心甲状腺癌质控专家委员会.中国甲状腺癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(9): 902-907.
National Cancer Center, Thyroid Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of thyroid cancer in China(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(9): 902-907.
[16] 国家癌症中心,国家肿瘤质控中心胃癌质控专家委员会.中国胃癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(10): 997-1002.
National Cancer Center, Gastric Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of gastric cancer in China(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(10): 997-1002.
[17] 中华人民共和国国家卫生健康委员会.国家卫生健康委办公厅关于印发肿瘤专业医疗质量控制指标(2023年版)的通知[EB/OL].(2023-03-13)[2024-11-13]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=d61a0abf132f4aaf9ebbb6d094764ad2.
[18] National Comprehensive Cancer Network. NCCN guidelines: head and neck cancers[EB/OL].[2024-11-13]. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437.
[19] Winchester DP.The assurance of quality care for the cancer patient[J]. Cancer,1990, 65(3 Suppl): 776-779.
[20] Ayanian JZ, Markel H.Donabedian’s lasting framework for health care quality[J]. N Engl J Med, 2016, 375(3): 205-207.
[21] Rosati RJ.The history of quality measurement in home health care[J]. Clin Geriatr Med, 2009, 25(1): 121-134.
[22] 邱亭林,林伟龙,马建辉,等.肿瘤规范化诊治现状及质量控制管理探讨[J].中国肿瘤, 2018, 27(5): 343-346.
Qiu TL, Lin WL, Ma JH, et al.Standard diagnosis and treatment of cancer and management of quality control[J]. China Cancer, 2018, 27(5): 343-346.
[23] Eskander A, Dziegielewski PT, Patel MR, et al.Oral cavity cancer surgical and nodal management a review from the American head and neck society[J]. JAMA Otolaryngol Head Neck Surg, 2024, 150(2): 172-178.