病理信息系统在质量管理中的作用

病理信息系统能够使标本进入科室后与之发生的所有活动都成为电子数据，不仅为病理诊断、科研和教学提供了良好的工作平台，同时也在质量管理的各个层次如质量控制中的流程管理、诊断管理、档案管理；质量保证中报告的及时性，诊断的错误率，冰冻切片诊断的准确性，病理报告中有关肿瘤分期的内容（如肿瘤的大小、切缘情况）是否完整等：以及相应的质量改进中发挥着重要的作用。病理信息学，现代质量管理学和分子病理学是当代病理学发展的重要支柱。     

强化病理实验室质量控制

病理技术的质量在很大程度上影响病理诊断质量，而病理诊断的优劣直接关系到病人的诊断和治疗．也是医院医疗质量优劣的重要标志。病理技术的质量取决于病理实验室的管理水平。只有认真的科学的实验室管理，才能保证病理技术质量。在目前的情况下，借鉴其它医学实验室的管理经验，认真提高病理实验室的管理水平，加强质量控制是目前病理界迫切的任务。文章阐述了其重要性及病理实验室管理的原则。     

上海市临床病理质量控制中心管理和运作

全文介绍了上海市临床专业质量控制中心及临床病理质量控制中心的管理模式，对申请挂靠质控中心的条件及管理和考核要求进行了介绍，对病理质控中心近年来开展的工作情况、所取得的成就及尚存在的问题进行了叙述。     

浙江省临床病理质控中心规范持久开展质控工作

本文详细介绍浙江省临床病理质控中心成立19年来在全省三级质控网络建设、《病理诊断与技术规范》的制定实施、病理科建设及质量控制以及专业队伍培训诸方面的管理评价情况，并对取得的成绩和目前尚存在的问题进行了阐述和讨论。     

华西医院病理科规范化管理和质量控制的尝试

全文从五个方面简要介绍了四川大学华西医院病理科在科室规范化管理和病理医疗工作的质量控制方面进行的一些尝试：（1）规范科室管理，制定必要的制度；（2）科室经营助理和专职科秘书的职能和作用：（3）开展住院医师规范化培训，把好病理医师的质量关和主治医师的上岗关；（4）做好病理诊断的质量管理工作，提高科室病理诊断的整体质量；（5）定期召开医疗工作会议．搭建起医生之间和医技之间沟通和交流的平台。     

小型科研课题的质量管理与控制

文章简要分析了小型科研课题主要特点、小型科研课题管理与控制的重要意义，阐述了小型科研课题管理中易出现的问题，并在此基础之上提出了加强小型科研课题的质量管理与控制的几点措施。     

医学科学研究的全面质量管理与控制

根据医学科研管理的基本规律,从医学科学研究的选题、立项、在研、结题4个基本环节,论述了实施医学科学研究全面质量管理与控制的具体措施与方法.     

肿瘤专科医院的医技质控管理

湖南省肿瘤医院对医技科室实行全员、全方位、全过程为主要内容的全面质量管理,使医疗质量有了明显提高,主要在以下四个方面有所创新;（1）健全医院院、科两组质量管理组织,完善质量控制网络;（2）制定医技科室的质量标准,实施按章奖罚;（3）深入科室,以抓医技环节质量来保证医疗质量;（4）按照各医技科室的考核标准进行了考核,并使奖惩得到落实。     

干部保健病房实施走动式管理效果初探

[目的]探讨干部保健病房实施走动式管理模式对干部保健质量安全控制和运行指标的效果。[方法]干部保健病房管理人员坚持每天不定时下病房,跟班巡查,了解临床工作的落实和医务人员的需求,并按照医院管理质量标准动态管理。走动式质量管理实施2年后,通过比较实施前后的质量和运行指标,评价其效果。[结果]实施走动式管理后,医疗护理质量、病史书写甲级率及患者满意度等5项质量控制指标高于实施前（P均〈0.05）,手术例数、平均住院日、病床周转率3项运行指标得分与实施行比较有统计学差异（P均〈0.05）。[结论]干部保健病房实施走动式管理,能及时发现工作中的不足并使其改进,以提高干部保健质量和服务能力。     

全面质量管理方法(TQM)在放射治疗中的应用

放射治疗技术日益复杂,跨学科趋势日益明显,这给放射治疗质量控制提出了更高的要求,大型放射治疗中心,尤其是基层放射治疗单位迫切需要建立一套系统的管理方法来对整个放疗流程进行监控,以保证放疗质量.本文参考国外和台湾地区将全面质量管理方法TQM引入到放射治疗管理的实践经验,针对国内放射治疗实际,对TQM在放射治疗中的应用作初步探讨.1     

放射治疗的质量保证与质量控制

文章主要阐述了放射治疗的质量管理,包括质量保证(QA)、质量控制(QC)、治疗计划和质量改进四个方面.QA是经过周密计划而采取的一系列必要措施,保证放射治疗的整个过程按国际标准安全地执行.QC是采取必要的措施保证QA的执行,并不断修改并进而达到新的QA级水平.     

Quality assessment in oncology

The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.     

Quality in Cancer Diagnosis

Improving the quality of oncologic pathology diagnosis is immensely important as the overwhelming majority of the approximately 1.6 million patients who will be diagnosed with cancer in 2010 have their diagnoses established through the pathologic interpretation of a tissue sample. Millions more patients have tissue samples obtained to rule out cancer and do not have cancer. The majority of studies on the quality of oncologic pathology diagnoses have focused on patient safety and have documented a variety of causes of error that occur in the clinical and pathology laboratory testing phases of diagnostic testing. The reported frequency of a diagnostic error made by oncologic pathology depends on several factors, such as definitions and detection methods, and ranges from 1% to 15%. The large majority of diagnostic errors do not result in severe harm, although mild to moderate harm in the form of additional testing or diagnostic delays occurs in up to 50% of errors. Clinical practitioners play an essential role in error reduction through several avenues such as effective test ordering, providing accurate and pertinent clinical information, procuring high‐quality specimens, providing timely follow‐up on test results, effectively communicating on potentially discrepant diagnoses, and advocating second opinions on the pathology diagnosis in specific situations. CA Cancer J Clin 2010;60:139–165. © 2010 American Cancer Society, Inc.     

Quality assurance in radiotherapy

In 1999, the European Organisation for Research and Treatment of Cancer (EORTC), being a European pioneer in the field of cancer research as well as in quality assurance (QA), launched an Emmanuel van der Schueren fellowship for QA in radiotherapy. In this paper, the work that has been done during the first E. van der Schueren fellowship is reported, focusing on four phase III EORTC clinical trials: 22921 for rectal cancer, 22961 and 22991 for prostate cancer and 22922 for breast cancer. A historical review of the QA programme of the EORTC Radiotherapy group during the past 20 years is included.     

Quality indicators in radiotherapy.

BACKGROUND AND PURPOSE: There is a widespread and increasing tendency to develop hospital performance indicators in the field of accreditation/certification systems and quality benchmarking. A study has been undertaken to develop a set of performance indicators for a typical radiotherapy Centre and to evaluate their ability to provide a continuous quality improvement. MATERIALS AND METHODS: A working group consisting of radiation oncologists, medical physicists and radiation technologists under the coordination of experts in health technology assessment has elaborated a set of general indicators able to monitor performances and the quality level of a typical radiotherapy Centre. The work has been carried out through four steps: a preliminary set of indicators was selected; data on these indicators were collected in a number of Italian radiotherapy Centres and medical physics Services; problems in collection and analysis of data were discussed; a final set of indicators was developed. RESULTS: A final set of 13 indicators is here presented. They concern general structural and/or operational features, health physics activities and accuracy and technical complexity of the treatment. CONCLUSIONS: The indicators tested in a few Italian Centres of radiotherapy and medical physics Services are now ready to be utilized by a larger community.     

Quality standards in radiation medicine

PurposeIdentifying and conducting “best practice” medicine is arguably the ubiquitous goal of practitioners. However, to distill the many available quality standards, guidelines, recommendations, and indicators down to a best practice set requires a logical schema to group standards addressing similar quality issues and, from manageable lists of related standards, to extract the essential dimensions of quality. The purpose of this study was to explore a method of collating publicly available quality standards, in this case in radiation therapy, using a 2-step decision tree approach with statistical analysis. Successful grouping into manageable lists, addressing related quality issues, informs the ongoing development of quality indicators that are one expression of “best practice.”Methods and materialsA comprehensive literature search was used to identify quality standards currently in use and publicly available. Using 2 decision trees, 5 evaluators assigned each standard to Donabedian's structure, process, or outcome and also to the target of the standard: patients, staff, equipment or clinical process, or organization for a total of 3 × 4 = 12 primary categories.ResultsA total of 454 radiation medicine program quality standards spread across 8 national and international documents was identified. Agreement between the 5 evaluators, using the free marginal kappa statistic, ranged from fair to almost perfect. In all but 2% of 5 × 454 evaluations were the evaluators able to assign a statement to categories in the decision trees suggesting that these trees are appropriate to the task. In only 3/454 was a majority (≥ 3/5) decision not reached on the assignment to structure, process, or outcome. Sixty-four percent of the standards were identified with structure, 26% with process and 10% with outcome.ConclusionsDonabedian's model constitutes a reliable method of managing quality standards. The 2-step decision tree framework can be applied to inform the further development of national and international quality standards.