Practice based collaboration to improve the use of immediate intravesical therapy after resection of nonmuscle invasive bladder cancer
| Autor: | Daniel S. Murtagh, James E. Montie, Alice Liu, Frank Burks, David L. Morris, Ronald S. Suh, Timothy G. Schuster, David C. Miller, Daniel A. Barocas, Rodney L. Dunn, Timothy J. Bradford, Peter M. Knapp, Don A. Moylan |
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| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Urinary bladder Bladder cancer Time Factors business.industry Urology Perioperative medicine.disease Combined Modality Therapy Quality Improvement Surgery Resection Pharmacotherapy medicine.anatomical_structure Administration Intravesical Urinary Bladder Neoplasms medicine Bladder tumor Humans Neoplasm Invasiveness Prospective Studies Educational interventions business Intravesical chemotherapy |
| Zdroj: | The Journal of urology. 190(6) |
| ISSN: | 1527-3792 |
| Popis: | Perioperative instillation of intravesical chemotherapy after bladder tumor resection is supported by level I evidence showing a 30% decrease in tumor recurrence. However, studies of administrative data sets show poor use in practice.We prospectively evaluated the use of perioperative intravesical chemotherapy in a multipractice quality improvement collaborative. Cases were categorized as ideal for intravesical chemotherapy (1 or 2 papillary tumors, cTa/cT1 and completely resected) and nonideal. The reasons for not administering intravesical chemotherapy in ideal cases were classified as appropriate or modifiable. Before and after comparative feedback and educational interventions we calculated judicious use of intravesical chemotherapy (nonuse in nonideal cases plus use in ideal cases plus appropriate nonuse in ideal cases) and quality improvement potential (use in nonideal cases plus nonuse in ideal cases attributable to modifiable factors).We accrued a total of 2,794 cases at the 5 sites in 22 months. The rate of use in ideal cases was 38% before and 34.8% after intervention (p=0.36), while use in nonideal cases decreased from 15% to 12% (p=0.08). Overall, intravesical chemotherapy was used judiciously in 83.0% to 85.7% of cases, while the remaining 14.3% to 17.0% represented quality improvement potential.Judicious use of perioperative intravesical chemotherapy is relatively high in routine practice. Most instances of nonuse represent appropriate clinical judgment. Utilization did not change after quality improvement interventions, suggesting that there may a ceiling effect that makes it difficult to improve care that is high quality at baseline. Moreover, decreasing unnecessary use of an intervention may be easier than encouraging appropriate use of potentially toxic therapy. |
| Databáze: | OpenAIRE |
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