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Persistence of Medical Change at Implementation of Clinical Guidelines on Medical Practice: A Controlled Study in a Cancer Network

From the Centre Léon Bérard; Groupe de Recherche en Economie de la Santé et Réseaux de Soins en Cancérologie, Lyon; Clinique La Digonnière, Saint-Etienne; Centre Hospitalier de Chambéry, Chambéry; Centre Hospitalier de Roanne, Roanne; Clinique de Rillieux, Rillieux; Centre Val d'Aurelle; Clinique Clementville, Montpellier; and Fédération Nationale des Centres de Lutte Contre le Cancer, Paris, France

Address reprint requests to Isabelle Ray-Coquard, MD, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; e-mail: ray{at}lyon.fnclcc.fr

PURPOSE: 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.

PATIENTS AND 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).

CONCLUSION: The CPG program for cancer management produced persistent changes in medical practice in our cancer network in terms of conformity with CPG.

Supported by ANAES and CNAM grants from the Ministry of Health (France).

Presented in part at the 39th Annual Meeting of American Society Clinical Oncology, Chicago, IL, May 31-June 3, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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