Impact of a clinical guidelines program for breast and colon cancer in a French cancer center
I. Ray-Coquard, T. Philip, M. Lehmann, B. Fervers, F. Farsi and F. Chauvin
Centre Leon Berard, Lyon, France. ray@lyon.fnclcc.fr
CONTEXT: Between 1993 and 1994, the 80 physicians in the French
comprehensive cancer center, Leon Berard, developed and implemented a
Clinical Practice Guidelines (CPGs) project based on an analysis of the
literature and a consensus of intrainstitutional experts. OBJECTIVE: The
aims of this project are to assist community-based oncologists in their
decision making and to minimize inappropriate variation in practices. A
study was designed to assess the impact of CPGs on management of breast and
colon cancer. DESIGN: A "before-after" study, using institutional
computerized records of patients with breast or colon cancer. SETTING:
Records for 100 women with localized breast cancer were randomly selected
from those available in 1993 and 1995, and those for all patients newly
referred with colon cancer in 1993 and 1995 (77 and 81 patients,
respectively). Medical decisions on these records were analyzed to assess
their compliance with the CPGs. (A systematic search of the literature was
performed to determine the scientific evidence for noncompliant decisions.)
RESULTS: Of 375 available medical decisions, 350 were assessable. The
compliance rate with CPGs for breast cancer was significantly higher in
1995 compared with 1993, 54% (54/99; 95% confidence interval [CI], 44%-64%)
vs 19% (18/95; 95% CI, 11%-27%) (P<.001). The compliance rate for colon
cancer was also significantly higher in 1995 than in 1993, 70% (62/88; 95%
CI, 60%-80%) vs 50% (34/ 68; 95% CI, 38%-62%) (P=.009). In 1993, 42%
(40/95; 95% CI, 32%-52%) of medical decisions for breast cancer and in
1995, 68% (67/99; 95% CI, 59%-77%) conformed with the CPGs or were judged
to be based on "scientific evidence." In 1993, 71% (48/68; 95% CI, 60%-81%)
of medical decisions for colon cancer, and in 1995 81% (71/88; 95% CI,
73%-89%) conformed with the CPGs or were judged to be based on scientific
evidence. CONCLUSIONS: Compliance rates were significantly higher in 1995
for both cancers. The development and implementation of CPGs for cancer
management seem to result in significant changes in medical practice,
although a causal relationship between changes and CPGs is not demonstrated
in this study.
"What's in the Black Box?"
Kunz
Chest 2006;129:7-10.
FULL TEXT
Persistence of Medical Change at Implementation of Clinical Guidelines on Medical Practice: A Controlled Study in a Cancer Network
Ray-Coquard et al.
JCO 2005;23:4414-4423.
ABSTRACT
| FULL TEXT
Predictors of high quality clinical practice guidelines: examples in oncology
Fervers et al.
Int J Qual Health Care 2005;17:123-132.
ABSTRACT
| FULL TEXT
International Assessment of the Quality of Clinical Practice Guidelines in Oncology Using the Appraisal of Guidelines and Research and Evaluation Instrument
Burgers et al.
JCO 2004;22:2000-2007.
ABSTRACT
| FULL TEXT
Conformity to clinical practice guidelines, multidisciplinary management and outcome of treatment for soft tissue sarcomas
Ray-Coquard et al.
Ann Oncol 2004;15:307-315.
ABSTRACT
| FULL TEXT
Critical appraisal of the Minimal Clinical Recommendations (MCR) of the European Society for Medical Oncology (ESMO): challenges for a European framework for the development of clinical practice guidelines
Fervers et al.
Ann Oncol 2002;13:1507-1509.
FULL TEXT
The Impact of Practice Guidelines in the Management of Barrett Esophagus: A National Prospective Cohort Study of Physicians
Cruz-Correa et al.
Arch Intern Med 2001;161:2588-2595.
ABSTRACT
| FULL TEXT
Ensuring Quality Cancer Care by the Use of Clinical Practice Guidelines and Critical Pathways
Smith and Hillner
JCO 2001;19:2886-2897.
ABSTRACT
| FULL TEXT
Economic Impact of Harmonizing Medical Practices: Compliance With Clinical Practice Guidelines in the Follow-Up of Breast Cancer in a French Comprehensive Cancer Center
Mille et al.
JCO 2000;18:1718-1724.
ABSTRACT
| FULL TEXT
Use of Hematopoietic Colony-Stimulating Factors: Comparison of the 1994 and 1997 American Society of Clinical Oncology Surveys Regarding ASCO Clinical Practice Guidelines
Bennett et al.
JCO 1999;17:3676-3681.
ABSTRACT
| FULL TEXT
Proposed Agenda for the Measurement of Quality-of-Care Outcomes in Oncology Practice
Mandelblatt et al.
JCO 1999;17:2614-2614.
ABSTRACT
| FULL TEXT
Guidelines Improve Cancer Screening Rates
JWatch Women's Health 1998;1998:10-10.
FULL TEXT
