Persistence of medical change at implementation of clinical guidelines on medical practice: a controlled study in a cancer network.
OBJECTIVE
A cancer network of general or private hospitals of a French region was started in 1995 for improving quality of care and rationalizing medical prescriptions. The impact of implementing a clinical practice guidelines (CPG) project assessed conformity with guidelines in medical practice; significant changes were observed within the network, whereas no changes were observed in a control region without cancer network. In the present study, we evaluated the persistence of conformity to guidelines through a new medical audit.


METHODS
In 1999, the hospitals of the previously compared experimental and control groups accepted to reassess the impact of CPG. A controlled transversal study was performed in the experimental group (cancer network) and in the control group (no regional cancer network). In 1996 (first audit) and in 1999 (present audit), all new patients with colon cancer (177 and 200 in experimental group and 118 and 100 in control group, respectively) and early breast cancer (444 and 381 in experimental group and 172 and 204 in control group, respectively) were selected.


RESULTS
In the experimental group, the compliance of medical decisions with CPG was significantly higher in 1999 than in 1996 for colon cancer (73%; 95% CI, 67% to 79% v 56%; 95% CI, 49% to 63%, respectively; P = .003) and similar for the two periods for breast cancer (36%; 95% CI, 31% to 41% v 40%; 95% CI, 35% to 44%, respectively; P = .24). In the control group, compliance was significantly higher in 1999 than in 1996 for colon cancer (67%; 95% CI, 58% to 76% v 38%; 95% CI, 29% to 47%, respectively; P < .001) and identical for the two periods for breast cancer (4%; 95% CI, 1% to 7% v 7%; 95% CI, 3% to 11%, respectively; P = .19).


CONCLUSIONS
The CPG program for cancer management produced persistent changes in medical practice in our cancer network in terms of conformity with CPG.
Ray-Coquard
Isabelle
I
Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France. ray@lyon.fnclcc.fr
Philip
Thierry
T
de Laroche
Guy
G
Froger
Xavier
X
Suchaud
Jean-Philippe
JP
Voloch
Alain
A
Mathieu-Daudé
Hélène
H
Lurkin
Antoine
A
Farsi
Fadila
F
Bertrand
Pierre
P
Chauvin
Franck
F
D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D002173:Cancer Care Facilities; D003110:Colonic Neoplasms / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D017410:Practice Guidelines as Topic