Impact of Using Audit Data to Improve the Evidence-Based Use of Single-Fraction Radiation Therapy for Bone Metastases in British Columbia.
OBJECTIVE
To assess the impact of a population-based intervention to increase the consistency and use of single-fraction radiation therapy (SFRT) for bone metastases.


METHODS
In 2012, an audit of radiation therapy prescriptions for bone metastases in British Columbia identified significant interphysician and -center (26%-73%) variation in the use of SFRT. Anonymous physician-level and identifiable regional cancer center SFRT use data were presented to all radiation oncologists, together with published guidelines, meta-analyses, and recommendations from practice leaders. The use of SFRT for bone metastases from 2007 through 2011 was compared with use of SFRT in 2013, to assess the impact of the audit and educational intervention. Multilevel logistic regression was used to assess the relationship between the usage of SFRT and the timing of the radiation while controlling for potentially confounding variables. Physician and center were included as group effects to account for the clustered structure of the data.


RESULTS
A total of 16,898 courses of RT were delivered from 2007 through 2011, and 3200 courses were delivered in 2013. The rates of SFRT use in 2007, 2008, 2009, 2010, 2011, and 2013 were 50.5%, 50.9%, 48.3%, 48.5%, 48.0%, and 59.7%, respectively (P<.001). Use of SFRT increased in each of 5 regional centers: A: 26% to 32%; B: 36% to 56%; C: 39% to 57%; D: 49% to 56%; and E: 73% to 85.0%. Use of SFRT was more consistent; 3 of 5 centers used SFRT for 56% to 57% of bone metastases RT courses. The regression analysis showed strong evidence that the usage of SFRT increased after the 2012 intervention (odds ratio 2.27, 95% confidence interval 2.06-2.50, P<.0001).


CONCLUSIONS
Assessed on a population basis, an audit-based intervention increased utilization of SFRT for bone metastases. The intervention reversed a trend to decreasing SFRT use, reduced costs, and improved patient convenience. This suggests that dissemination of programmatic quality indicators in oncology can lead to increased utilization of evidence-based practice.
BC Cancer Agency-Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: rolson2@bccancer.bc.ca.
Robert A
RA
Olson
BC Cancer Agency-Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
Manpreet
M
Tiwana
BC Cancer Agency-Centre for the North, Prince George, British Columbia, Canada.
Mark
M
Barnes
BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada.
Eric
E
Cai
BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada.
Colleen
C
McGahan
University of British Columbia, Vancouver, British Columbia, Canada.
Kelsey
K
Roden
University of Northern British Columbia, Prince George, British Columbia, Canada.
Emily
E
Yurkowski
University of British Columbia, Vancouver, British Columbia, Canada.
Quinn
Q
Gentles
BC Cancer Agency-Vancouver Centre, Vancouver, British Columbia, Canada.
John
J
French
University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Agency-Centre for the Southern Interior, Kelowna, British Columbia, Canada.
Ross
R
Halperin
University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada.
Ivo A
IA
Olivotto
D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001955:British Columbia; D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D019583:Dose Fractionation, Radiation; D055317:Evidence-Based Practice / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010146:Pain / Q000532:radiotherapy; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D018787:Radiation Oncology / Q000592:standards*; D011878:Radiotherapy / Q000706:statistics & numerical data; D012044:Regression Analysis