전립선암 의료 질 관리 방안 및 평가기준 개발

Abstract

Purpose: To improve the quality of life of the people by identifying the current status and quality of treatment for prostate cancer patients in Korea and preparing evaluation plans for treatment and prevention of complications by appropriate treatment policies according to the individual condition, stage, and risk of prostate cancer patients We want to contribute to the improvement and promotion of public health. Methods: Domestic and foreign literature, papers, research reports, and application cases related to the evaluation and management of medical care for prostate cancer were reviewed. Diagnosis method, treatment method, and follow-up observation by risk level considering the stage and degree of differentiation of prostate cancer using claim data from the Health Insurance Review and Assessment Service for 3 years from 2019 to 2021 and treatment data from 4 medical institutions at the level of a tertiary hospital during the same period We identified and analyzed the status of treatment, including methods, complications, recurrence rate, and mortality. The current status and problems of medical quality control were diagnosed in relation to prostate cancer treatment and follow-up, complications, recurrence or treatment after progression. In order to prepare an evaluation plan to solve the problem of medical quality of prostate cancer, evaluation targets considering the characteristics of prostate cancer were set, and evaluation indexes (draft) and standards (draft) were developed. Results: Among the common cancer evaluation indicators, indicators that can be applied to prostate cancer are the composition of specialists (specialists for each specialty), the ratio of multidisciplinary care for cancer patients, the ratio of severely ill patients among surgery patients, the rate of educational counseling for cancer patients, Rate of admission to intensive care unit before death of cancer patients (patients who died in stage IV), rate of chemotherapy before death of cancer patients (patients who died of stage IV), hospice counseling rate of cancer patients, and proportion of patients who underwent surgery within 30 days after cancer diagnosis However, the number of hospitalization days and long-term index can be applied as an index if the detailed criteria can be changed or corrected. The rate of PSA examination within 3 months after surgery, the rate of adjuvant radiation therapy after surgery, and the rate of BMD in patients who underwent ADT for more than 1 year are valid enough to be applied as specific evaluation indicators for prostate cancer. Conclusions: If diagnosed early, prostate cancer can be treated with active surveillance therapy and the progress is good enough to delay fundamental treatment such as surgery. . Therefore, treatment methods vary according to the patient's condition, the risk of local cancer, and whether or not it is advanced, and a method suitable for each patient should be applied. Since we have developed an evaluation index that improves the quality and adequacy of medical services for prostate cancer, we hope that it will be applied in the future to contribute to appropriate treatment and quality of life for prostate cancer patients.