QS132 - Results of a Multimodal Intervention to Increase TME Grading for Rectal Cancer in Michigan

Sunday, June 2, 2024

1:54 PM – 1:57 PM ET, USA

Location: Room 327

Quick Shot Presenter(s)

JV

Joceline V. Vu, MD

Assistant Professor
Temple University Hospital
Philadelphia, Pennsylvania, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

AK

Arielle Kanters, MD, MS

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
mB

mariana Berho, n/a

Staff
Cleveland Clinic
Weston, Florida, United States

Disclosure information not submitted.
SR

Samantha Rivard, n/a

Fellow
University of Massachusetts
Worcester, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
BS

Brandy R. Sinco, MS

Statistician Senior
University of Michigan Medical School
Ann Arbor, Michigan, United States

Disclosure information not submitted.
AD

Ashley Duby, MS

Research Director
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.
KS

Kushal Singh, n/a

Statistician
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.
MB

Mousumi Banerjee, n/a

Statistician
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.

Senior Author(s)

Samantha Hendren, MD, MPH (she/her/hers)

Associate Professor
University of Michigan
University of Michigan
Ann Arbor, Michigan, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: The total mesorectal excision (TME) surgical technique is associated with improved outcomes for rectal cancer, and TME grading is recommended; however, we found poor adoption of TME grading in Michigan. We implemented a multimodal intervention in Michigan Surgical Quality Collaborative (MSQC) hospitals to increase TME grading. In this study we compare rates of TME grading over time between hospitals that received the intervention early and late in the study period.

Methods/Interventions: This was a stepped-wedge cluster randomized controlled trial, where hospitals were randomized to receive a multimodal intervention consisting of a webinar about TME grading, a pre- and post-webinar quiz, and site visits. One group received the intervention at the start of the study while the second group received it one year later. We compared rates of TME grading over time using a generalized linear mixed model for longitudinal change in between groups, adjusting for clustering within hospitals and hospital characteristics.

Results/Outcomes: From 2014 and 2021, 560 patients underwent TME in the MSQC, 350 at early-intervention hospitals and 210 in late-intervention hospitals. There were no significant differences in hospital characteristics between the five early and seven late hospitals. Based on the mixed model, grading in early hospitals increased from 8.1% (95% CI 1.2% – 39.1%) to 99.7% at the end of the study (95% CI 97.7% – 100.0) p< 0.001. In the late group, grading increased from 47.8% at baseline (95% CI 13.9% – 83.9%) to 94.0% (95% CI 76.4% – 98.7%) p< 0.001. The date of the webinar intervention was not associated with a change in the slope of TME grading uptake; rather, the increase in grading corresponded with recruitment of hospitals for the study and a statewide MSQC presentation on this topic in December 2016.

Conclusion/Discussion: Our findings show a striking increase in TME grading in Michigan from 2014-2021. However, the timing of improvement was associated with a statewide presentation about TME grading which preceded the dates of our multimodal intervention. These results highlight the importance of accounting for secular trends in measuring healthcare quality improvement interventions.