Table 1.
Summary of literature describing interventions to improve physician compliance to prostate cancer imaging guidelines and associated outcomes15,23–26
| Intervention | Study methods summary | Authors; year | n | Statistical significance | Baseline rate of low-risk scanning | Reduction in low-risk PCa scans | Absolute risk reduction | Number needed to treat | Comments |
|---|---|---|---|---|---|---|---|---|---|
| Education, champion, feedback | Imaging patterns compared before & after multistep performance feedback & guideline review led by practice clinical champion | Ross I, et al; 201523 | 813 | p=0.03 (BS) p=0.17 (CT) |
3.7% (BS) 5.2% (CT) |
65% (BS) 38% (CT) |
2.4% (BS) 2% (CT) |
42 (BS) 50 (CT) |
100% of scans were negative; 19 practices in Michigan |
| Education, champion, feedback | Baseline imaging rates compared before & after year of champion-led education & performance feedback with site visits | Hurley P, et al; 201715 | 10,554 | p<0.0001 (BS and CT) | 11.0% (BS) 14.7% (CT) |
41% (BS) 48% (CT) |
4.5% (BS) 7% (CT) |
23 (BS) 15 (CT) |
98.4% (BS) and 99.7% (CT) of scans were negative. Increase in indicated imaging also observed (not statistically significant) |
| Education, champion, feedback | Baseline phase followed by 2 phases with champion-led comparative performance feedback & guideline education | Miller DC, et al; 201124 | 858 | p<0.01 (BS and CT) | 31% (BS) 28% (CT) |
48% (BS) 54% (CT) |
15% (BS) 15% (CT) |
7 (BS) 7 (CT) |
97.6% (BS) and 96.4% (CT) of scans were negative. Reduced practice variation & improved guideline adherence |
| Education, champion, feedback | Local champion led guideline education. Participating urologists staging practices audited & presented (deidentified) | Rutledge AB, et al; 201826 | 144 | p=0.84 (BS) p=0.01 (CT) |
21.4% (BS) 42.9% (CT) |
15% (BS) 100% (CT) |
3.2% (BS) 42.9% (CT) |
32 (BS) 3 (CT) |
Only low-risk patients reflected here; this Australian study also reported reduced scans among intermediate-risk patients |
| EMR CROC | Imaging rates per VA claims compared before & after CROC implementation | Ciprut SE, et al; 202025 | 433 | p=0.001 (BS and CT combined) | 35% (BS and CT combined) | 46% (BS and CT combined) | 16% (BS & CT combined) | 7 (BS & CT combined) | BS & CT data not delineated |
BS: bone scan; CROC: clinical reminder order check; CT: computed tomography; EMR: electronic medical record; PCa: prostate cancer; VA: Veterans Affairs.