Greater awareness of practice guidelines helps reduce unrecommended tests

A physician-driven approach cut in half the number of unwarranted tests that doctors ordered for newly diagnosed prostate cancer patients, research shows.

Increased awareness of practice guidelines and being presented with comparative data on tests they and their colleagues ordered resulted in more physicians following recommendations on what tests to order, according to a study in the September issue of The Journal of Urology (link). It also improved the quality of care by reducing variations in practice patterns.

Fewer unnecessary tests -- in this case bone scans and computerized tomography scans -- mean fewer patients are exposed to radiation and the inherent risks. They also avoid needless costs to the health care system, said lead author David C. Miller, MD, MPH.

"This approach was physician-led. ... It's a new solution to an old problem," said Dr. Miller, a urologist and an assistant professor at the University of Michigan Medical School in Ann Arbor. "This was about enhancing transparency and providing the very best care for patients."

The study involved three urological practices that participated in the Urological Surgery Quality Collaborative, a group of more than 150 urologists from practices in Ohio, Indiana, Michigan and Virginia that came together in 2009 to find ways to improve quality.

Study authors collected data on bone scans and CT scans ordered for 858 men with prostate cancer. Among the newly diagnosed men, 44% had low-risk cancer, 39% had intermediate-risk cancer and 17% had high-risk cancer based on the D'Amico classification.

When the study began, 31% of patients had bone scans and 28% had CT scans. After the baseline numbers were calculated, urologists were given comparative data and results of the imaging studies. They also received American Urological Assn. and National Comprehensive Cancer Network guidelines for staging evaluations in men with early-stage prostate cancer.

The number of patients receiving the tests dropped: 23% received bone scans, and 21% received CT scans.

The number dropped again after physicians received data and used a new information collection form that included a summary of the practice guidelines: 16% of patients received bone scans, and 13% received CT scans.

Among patients with low-risk cancer, the drop was particularly dramatic. By the end of the study, the number of low-risk patients receiving CT scans dropped to 2%, down from 14%. Patients receiving bone scans dropped to 1%, down from 10%.