A Strategy for Changing Adherence to National Guidelines for Decreasing Laboratory Testing for Early Breast Cancer Patients

• Published in: Wisconsin medical journal (Madison, Wis.) Vol. 117; no. 2; pp. 68 - 72
• Main Authors: Hill, Laura A, Vang, Choua A, Kennedy, Colin R, Linebarger, Jared H, Dietrich, Leah L, Parsons, Benjamin M, Hennessy, Joy L, Theede, Lonna M, VanderLei, Laura K, Ramirez, Luis D, Ernst, Andrew J, Landercasper, Jeffrey
• Format: Journal Article
• Language: English
• Published: United States 01.06.2018
• Subjects: Adult; Aged; Breast Neoplasms - diagnosis; Breast Neoplasms - economics; Breast Neoplasms - pathology; Cost-Benefit Analysis; Diagnostic Tests, Routine - economics; Diagnostic Tests, Routine - standards; Evidence-Based Medicine; Female; Guideline Adherence; Humans; Mass Screening - economics; Mass Screening - standards; Middle Aged; Neoplasm Staging; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - statistics & numerical data; United States; United States
• ISSN: 1098-1861

Past studies indicate delays in adoption of consensus-based guideline updates. In June 2016, the National Comprehensive Cancer Network changed its guidelines from routine testing to omission of ordering complete blood cell count (CBC) and liver function tests (LFT) in patients with early breast cancer. In response, we developed an implementation strategy to discontinue our historical practice of routine ordering of these tests in asymptomatic patients. The ordering of CBC and LFT for clinical stage I-IIIA breast cancer patients was audited in 2016. In June 2016, we utilized the levers of the National Quality Strategy implementation methodology to enact a system-wide change to omit routine ordering. To measure the plan's effectiveness, guideline compliance for ordering was tracked continually. Of 92 patients with early stage cancer in 2016, the overall rate of compliance with guidelines for ordering a CBC and LFT was 82% (88/107) and 87% (93/107), respectively. Segregated by the pre- and post-guideline change time period, the compliance rates for ordering a CBC and LFT were 78% and 87% ( = 0.076). In contrast to historical reports of delays in adoption of new evidence-based guideline changes, we were able to quickly change provider practice during the transition from routine ordering to omission of ordering screening blood tests in newly diagnosed patients with early breast cancer.