Staging Documentation Accuracy And Adherence To Workup And Treatment Guidelines: The M. D. Anderson Regional Care Center Experience

244 Background: MD Anderson Cancer (MDACC) disease-specific faculty experts have developed institutional guidelines for diagnostic workup and treatment of common tumor types. The institution has four Regional Care Centers in suburban Houston staffed by a total of 10general medical oncologists. The primary intent of this project was to measure the accuracy of staging documentation and adherence to guidelines. The secondary intent was to improve documentation and guideline adherence by regularly reporting results directly to the involved physicians.Between July 2009 and April 2012, charts for all new medical oncology visits for patients with breast, non-small cell lung, or colon cancer for whom no previous medical oncology plan had been implemented were reviewed by a team of quality nurses on a weekly basis. Source documents were analyzed for (a) adherence to MDACC diagnostic workup guidelines (n=782); (b) accuracy of both TNM and AJCC staging documentation (n=782); and (c) adherence to MDACC treatment guidelines (n=731). On a monthly basis, a graph with rates over time of guideline adherence and accuracy of staging documentation was provided to each general oncologist.The adherence rate to MDACC diagnostic workup guidelines was 79%. The agreement rate for accurate documentation of both TNM and AJCC stage was 72%. The adherence rate to MDACC treatment guidelines was 94%. Providing monthly reports of individual results to each physician did not lead to an increase in the rates of adherence of accurate staging documentation. Analysis comparing all Regional Care Center medical oncologists (not provided to the involved physicians) showed significant variation in rates for all three categories.Providing MDACC Regional Care Center general medical oncologists with simple graphs over time reflecting guideline adherence and accuracy of documentation did not lead to any improvement on those measures. More creative interventions to improve performance in these realms will need to be explored.