International Journal for Quality in Health Care Advance Access originally published online on August 22, 2009
International Journal for Quality in Health Care 2009 21(5):372-378; doi:10.1093/intqhc/mzp037
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Change in clinical practice after publication of guidelines on breast cancer treatment
1 Institute for Health Economics and Policy, 1-5-11-2F, Nishi-Shinbashi, Minato-Ku, Tokyo 105-0003, Japan
2 Department of Healthcare Economics and Quality Management, School of Public Health, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
Objective. Several studies raise questions about whether clinical practice guidelines actually guide practice. We evaluated patterns of use of breast-conserving surgery (BCS) over time to examine the effect of guideline publication.
Design. Retrospective analysis of time-series data on breast cancer treatment. Multiple logistic regression analysis was performed, adjusting for covariates including the patient's age, comorbidity status and admission year, to assess whether the use of BCS was higher after publication of treatment guidelines.
Setting. Five teaching hospitals participating in the Quality Improvement/Indicator Project (QIP) in Japan.
Participants. Female breast cancer patients who received surgical treatment at five teaching hospitals from January 1996 through December 2007 (n = 2199).
Main Outcome Measure. Rates of use of BCS.
Results. The proportion of BCS use increased from 26.4% before guideline publication to 59.9% after guideline publication in Japan. After controlling for other characteristics, the use of BCS has increased significantly over time, especially since 2001. Women aged 70 years and older (P=0.004) and those with any comorbidity (P < 0.001) were significantly less likely to receive BCS.
Conclusions. This study demonstrated that the adjusted proportion of BCS has increased dramatically since 2001, 2 years after guideline publication in Japan and this is consistent with a relationship between guideline publication and a change in this clinical practice.
Keywords: breast cancer, breast-conserving surgery, guideline, practice variations
Address reprint requests to: Yuichi Imanaka, Department of Healthcare Economics and Quality Management, School of Public Health, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Tel: +81-75-753-4454; Fax: +81-75-753-4455; E-mail: imanaka-y{at}umin.net
Accepted for publication July 29, 2009.