University of Wisconsin–Madison Medical College of Wisconsin

A Strategy for Changing Adherence to National Guidelines for Decreasing Laboratory Testing for Early Breast Cancer Patients

Laura A. Hill, MD; Choua A. Vang, BS; Colin R. Kennedy, MD; Jared H. Linebarger, MD; Leah L. Dietrich, MD; Benjamin M. Parsons, DO; Joy L. Hennessy, RN; Lonna M. Theede, RN; Laura K. VanderLei, PA-C; Luis D. Ramirez, MPH; Andrew J. Ernst, BS; Jeffrey Landercasper, MD

WMJ. 2019;118(1):68-72.

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Introduction: Past studies indicate delays in adoption of consensus-based guideline updates. In June 2016, the National Comprehensive Cancer Network changed its guidelines from routine testing to omission of ordering complete blood cell count (CBC) and liver function tests (LFT) in patients with early breast cancer. In response, we developed an implementation strategy to discontinue our historical practice of routine ordering of these tests in asymptomatic patients.

Methods: The ordering of CBC and LFT for clinical stage I-IIIA breast cancer patients was audited in 2016. In June 2016, we utilized the levers of the National Quality Strategy implementation methodology to enact a system-wide change to omit routine ordering. To measure the plan’s effectiveness, guideline compliance for ordering was tracked continually.

Results: Of 92 patients with early stage cancer in 2016, the overall rate of compliance with guidelines for ordering a CBC and LFT was 82% (88/107) and 87% (93/107), respectively. Segregated by the pre- and post-guideline change time period, the compliance rates for ordering a CBC and LFT were 78% and 87% (P = 0.076).

Conclusion: In contrast to historical reports of delays in adoption of new evidence-based guideline changes, we were able to quickly change provider practice during the transition from routine ordering to omission of ordering screening blood tests in newly diagnosed patients with early breast cancer.

Author Affiliations: Department of Medical Education (Hill, Kennedy), Department of Medical Research (Vang, Ramirez, Ernst, Landercasper), Gundersen Medical Foundation, La Crosse, Wis; Department of General Surgery (Linebarger, VanderLei), Department of Medical Oncology (Dietrich, Parsons), Norma J. Vinger Center for Breast Care (Linebarger, Hennessy, Theede, VanderLei, Landercasper), Gundersen Health System, La Crosse, Wis.
Corresponding Author: Jeffrey Landercasper, MD, Gundersen Medical Foundation, 1900 South Ave, Mailstop C03-006B, La Crosse, WI 54601; phone 608.775.5695; fax 608.775.1565; email
Acknowledgements: Portions of these data were presented by Laura Hill, MD, as a poster during the Wisconsin Surgical Society Annual Meeting on November 4, 2016 in Kohler, Wisconsin.
Funding/Support: The authors would like to thank the Norma J. Vinger Center for Breast Care, the Gundersen Health System, and the Gundersen Medical Foundation for their financial support of this project.
Financial Disclosures: None declared.
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