肿瘤住院患者治疗质量控制与分析:来自北京市9家医院的访谈与病历调查  

Quality Control and Analysis of Treatment for Hospitalized Cancer Patients:Interview and Medical Records Study from Nine Hospitals in Beijing

作　　者：卢丽婷 周艳萍[1] 王湘[1] 李孝远[1] 侯晓荣[2] 朱立东[3] 徐小红[4] 孙桂彬[5] 王子元 张杰石[6] 赵林[1] 巴一 LU Liting;ZHOU Yanping;WANG Xiang;LI Xiaoyuan;HOU Xiaorong;ZHU Lidong;XU Xiaohong;SUN Guibin;WANG Ziyuan;ZHANG Jieshi;ZHAO Lin;BA Yi(Department of Medical Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of General Surgery,Beijing Puren Hospital,Beijing 100062,China;Department of Gynecological Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100020,China;Department of Medical Oncology,Beijing Puren Hospital,Beijing 100062,China;Department of Medical Affairs,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院肿瘤内科,北京100730 [2]中国医学科学院北京协和医院放疗科,北京100730 [3]北京市普仁医院普通外科,北京100062 [4]首都医科大学附属北京妇产医院妇瘤科,北京100020 [5]北京市普仁医院肿瘤科,北京100062 [6]中国医学科学院北京协和医院医务处,北京100730

出　　处：《协和医学杂志》2025年第2期399-405,共7页Medical Journal of Peking Union Medical College Hospital

摘　　要：目的分析北京市当前肿瘤住院患者的治疗质量,识别治疗实践中存在的主要问题并提出改进意见,为完善我国癌症防治体系提供参考依据。方法选取北京市9家医院作为检查对象,通过专家现场访谈及病历抽查,采用《北京市肿瘤诊疗质控检查表》对抽检医院2023年1—10月抗肿瘤治疗过程中的硬件、管理、药物治疗、放射治疗、手术治疗等方面进行评估,分析肿瘤治疗中存在的问题。结果在接受检查的9家医院中,仅2家(22.2%)配备层流室,3家(33.3%)建有静脉药物配置中心。制度管理方面,7家(77.8%)抗肿瘤药物处方权限管理规范,8家(88.9%)应急预案完备,5家(55.6%)有肿瘤专科药师。抗肿瘤药物治疗方面,病理诊断支持率(97.6%)、治疗前常规检查完整率(96.3%)、不良反应处理得当率(92.7%)、出院小结(95.1%)和入院病史记录(91.5%)完整率较高。治疗前TNM分期准确率(70.7%)及后续疗效评价完整率(76.9%)尚需加强。肿瘤专科在TNM分期准确率(86.0%比46.9%,P<0.001)及知情同意书完整度(100%比68.8%,P<0.001)、药物适应证评价完整率(96.0%比78.1%,P=0.025)、入院病史记录完整率(98.0%比81.3%,P=0.008)、药物剂量合理率(96.0%比75.0%,P=0.005)、药物输注时间合理率(100%比62.5%,P<0.001)和药物输注顺序合理率(100%比87.5%,P=0.010)方面均明显优于非肿瘤专科。放射治疗方面,整体质量较高,但后续疗效评价恰当率仅为39.3%,需进一步加强。手术治疗方面,术前病理诊断支持率(78.1%)、TNM分期准确率(37.5%)均较低,存在术前评估不全及多学科讨论缺失问题。结论我国肿瘤治疗质量仍有较大提升空间,建议未来通过规范肿瘤分期评估流程、加强对非肿瘤专业科室的准入考核、推动多学科诊疗模式实施、建立多部门联合管理模式,对肿瘤诊疗质量相关指标进行严密监测,以促进肿瘤诊疗质量持续改进。Objective To analyze the current quality of treatment for hospitalized cancer patients in Bei⁃jing,identify major issues in treatment practices,and propose improvements.Methods Nine hospitals in Beijing were selected for examination.Expert on⁃site interviews and medical record sampling were conducted.The“Bei⁃jing Cancer Diagnosis and Treatment Quality Control Checklist”was used to assess the hardware,management,anti⁃cancer drug therapy,radiation therapy,and surgical treatment during cancer treatment at these hospitals from January to October 2023.The relevant problems were analyzed.Results Among the nine hospitals,two(22.2%)were equipped with laminar flow rooms,and three(33.3%)had intravenous drug preparation centers.In terms of institutional management,seven hospitals(77.8%)had standardized anti⁃cancer drug prescription authority management,eight(88.9%)had complete emergency plans,and five(55.6%)had oncology specialist pharmacists.Regarding anti⁃cancer drug therapy,the areas with higher completion rates included pathology diag⁃nosis support(97.6%),routine pre⁃treatment examinations(96.3%),adverse reaction evaluation(92.7%),discharge summaries(95.1%),and admission records(91.5%).However,the accuracy of tumor staging before treatment(70.7%)and the evaluation of therapeutic efficacy after drug treatment(76.9%)needed improvement.The oncology specialty significantly outperformed the non⁃oncology specialty in terms of the accuracy rate of TNM staging(86.0%vs.46.9%,P<0.001),the completeness of informed consent forms(100%vs.68.8%,P<0.001),the completeness of drug indication evaluation(96.0%vs.78.1%,P=0.025),the completeness of admission medical history records(98.0%vs.81.3%,P=0.008),the rationality of drug dosage(96.0%vs.75.0%,P=0.005),the rationality of drug infusion time(100%vs.62.5%,P<0.001),and the rationality of the order of drug infusion(100%vs.87.5%,P=0.010).Although the quality of radiation therapy was high,the subsequent evaluation of therapeutic efficacy(39.3%)requires enhancement.In surg

关 键 词：恶性肿瘤 诊疗 质量控制 质量改进 规范化 

分 类 号：R73[医药卫生—肿瘤] R194[医药卫生—临床医学]