Article ; Online: Caution Ahead: Research Challenges of a Randomized Controlled Trial Implemented to Improve Breast Cancer Treatment at Safety-Net Hospitals.
2018 Volume 14, Issue 3, Page(s) e158–e167
Abstract: Purpose: To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs).: Patient and methods: We randomly assigned 10 SNHs, identified ... ...
| Abstract | Purpose: To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs). Patient and methods: We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool's usefulness. We conducted intention-to-treat and pre- and poststudy analyses to assess the T&F tool and implementation effectiveness, respectively. Results: Between the study start and intervention implementation, several hospitals reorganized care delivery and 49% of patients scheduled to undergo breast cancer surgery were ineligible because they already were in contact with an oncologist. One high-volume hospital closed. Despite randomization of hospitals, intervention (INT) hospitals had fewer white patients (5% v 16%; P = .0005), and more underuse (28% v 15%; P = .002) compared with usual care (UC) hospitals. Over time, INT hospitals with poorer follow-up significantly reduced underuse compared with UC hospitals (INT hospitals, from 33% to 9%, P = .001 v UC hospitals, from 15% to 11%, P = .5). There was no difference in underuse (9% at INT hospitals, 11% at UC hospitals; P = .8). Hospitals with better follow-up (odds ratio, 0.85; 95% CI, 0.73 to 0.98) had less underuse. In settings with poor follow-up and tracking approaches, key informants found the tool useful. The rapidly changing delivery landscape posed significant challenges to this implementation research. Conclusion: A T&F tool did not significantly reduce adjuvant underuse but may help reduce underuse in SNHs with poor follow-up capabilities. Inability to discern T&F effectiveness is likely due to encountered challenges that inform lessons for future implementation research. |
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| MeSH term(s) | Breast Neoplasms/diagnosis ; Breast Neoplasms/epidemiology ; Breast Neoplasms/therapy ; Female ; Hospitals ; Humans ; Intention to Treat Analysis ; Medical Informatics Applications ; New York City ; Quality Improvement ; Randomized Controlled Trials as Topic ; Safety-net Providers/methods ; Safety-net Providers/standards ; Treatment Outcome |
| Language | English |
| Publishing date | 2018-01-03 |
| Publishing country | United States |
| Document type | Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural |
| ZDB-ID | 2236338-5 |
| ISSN | 1935-469X ; 1554-7477 |
| ISSN (online) | 1935-469X |
| ISSN | 1554-7477 |
| DOI | 10.1200/JOP.2017.026534 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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