TY - JOUR
T1 - Change in clinical practice after publication of guidelines on breast cancer treatment
AU - Fukuda, Haruhisa
AU - Imanaka, Yuichi
AU - Ishizaki, Tatsuro
AU - Okuma, Kazuhide
AU - Shirai, Takako
N1 - Funding Information:
The work described in this article was funded in part by the Health Sciences Research Grants for the Research on Policy Planning and Evaluation from the Ministry of Health, Labor and Welfare of Japan and the Grant-in-aid for Scientific Research A from the Ministry of Education, Culture, Sports, Science and Technology of Japan.
PY - 2009
Y1 - 2009
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=70349545857&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349545857&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzp037
DO - 10.1093/intqhc/mzp037
M3 - Article
C2 - 19700780
AN - SCOPUS:70349545857
VL - 21
SP - 372
EP - 378
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
SN - 1353-4505
IS - 5
ER -