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首页> 美国卫生研究院文献>Translational Lung Cancer Research >What is quality and can we define it in lung cancer?—the case for quality improvement
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What is quality and can we define it in lung cancer?—the case for quality improvement

机译：什么是质量我们可以在肺癌中定义质量吗？—提高质量的理由

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Decades worth of advances in diagnostics and therapeutics are associated with only marginal improvements in survival among lung cancer patients. An obvious explanation is late stage at presentation, but gaps in the quality of care may be another reason for stifled improvements in survival rates. A framework for quality put forth by Avedis Donabedian consists of measuring structures-of-care, processes, and outcomes. Using this approach to explore for potential quality gaps, there is evidence of inexplicable variability in outcomes across patients and hospitals; variation in outcomes across differing provider types (structures-of-care); and variation in approaches to staging (processes-of-care). However, this research has limitations and incontrovertible evidence of quality gaps is challenging to obtain. Other challenges to defining quality include scientific and clinical uncertainty among providers and the fact that quality is a multi-dimensional construct that cannot be measured by a single metric. Nonetheless, two facts compel us to pursue quality improvement: (I) both empirically and anecdotally, actual care falls short of expected care; and (II) evidence of potential quality gaps is not ignorable primarily on ethical grounds.
机译：在诊断学和治疗学上数十年的进步仅与肺癌患者生存率的微小提高有关。一个明显的解释是在就诊时处于晚期，但是医疗质量的差距可能是生存率明显提高的另一个原因。 Avedis Donabedian提出的质量框架包括衡量医疗结构，流程和结果。使用这种方法探索潜在的质量差距，有证据表明患者和医院之间的结果存在无法解释的差异；不同提供者类型（护理结构）的结果差异；以及分期方法（护理过程）的变化。但是，这项研究有局限性，并且很难获得质量差距的确凿证据。定义质量的其他挑战包括提供者之间的科学和临床不确定性，以及质量是一个多维结构，无法用单个指标来衡量的事实。但是，有两个事实迫使我们追求质量改进：（I）从经验和轶事上看，实际护理均达不到预期的护理； （II）潜在的质量差距证据主要基于道德理由是不可忽略的。

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