Practice standardization in the staging and treatment of colon cancer at Intermountain Healthcare.

Abstract

6053 Background: Intermountain Healthcare is a network of 24 urban and rural hospitals including 9 comprehensive cancer centers serving Utah and southeastern Idaho. This project builds on the institution's long history of quality improvement and was undertaken to standardize the treatment of colon cancer with respect to surgery, pathology and medical oncology. Methods: A multidisciplinary physician-based development team identified the treatment of colon cancer as an area of interest, collected baseline data to assess current practice, and developed system wide goals to ensure optimal staging and treatment for patients. Following a review of existing literature and an evaluation of national guidelines, the team set a goal to remove and evaluate at least 12 lymph nodes in 90% of stage I-III colon cancer patients who undergo resection with curative intent. The next year the development team added a goal to ensure that 80% of stage III colon cancer patients receive chemotherapy. Both goals were developed and implemented using a similar process of ongoing data collection, analysis and feedback, physician education, regular review of noncompliant charts and constant monitoring by the development team. Both goals are still monitored on an ongoing basis. Results: Lymph node removal data were collected on all stage I-III colon cancer patients undergoing potentially curative colon cancer resection after January 1, 2007. Following standardization, the percentage of cases in which a minimum of 12 lymph nodes were evaluated increased from 78.8% (n = 99) to 95.1% (n = 102) (p = 0.001). Likewise, the percent of stage III colon cancer patients undergoing surgery beginning January 1, 2008 who received chemotherapy increased from 68.2% (n = 44) to 86.5% (n = 37) (p = 0.068). Following standardization, all 37 stage III patients were seen by a medical oncologist in consultation and offered chemotherapy. Conclusions: Practice standardization is crucial to ensuring the adoption and adherence to best practice guidelines and can be achieved in multiple hospitals and among multiple physician specialties. This requires validated organizational processes, physician leadership, ongoing data collection and constant monitoring. No significant financial relationships to disclose.