NDLI: A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study

Content Provider	Springer Nature : BioMed Central
Author	Eskander, Antoine Sahovaler, Axel Shin, Jennifer Deutsch, Konrado Crowson, Matthew Goyal, Neerav Witsell, David L. Schulz, Kristine Gross, Neil D. Weber, Randal Khariwala, Samir S. Cohen, Seth CyrLee, Derek Walter Mehta, Vikas
Abstract	Background To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. Methods Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. Results A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). Conclusion Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. Clinical relevance This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.
Related Links	https://bmcoralhealth.biomedcentral.com/counter/pdf/10.1186/s12903-021-01616-x.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	14726831
DOI	10.1186/s12903-021-01616-x
Journal	BMC Oral Health
Issue Number	1
Volume Number	21
Language	English
Publisher	BioMed Central
Publisher Date	2021-05-17
Access Restriction	Open
Subject Keyword	Dentistry Oral and Maxillofacial Surgery Guideline-recommended processes of care MarketScan Oral cavity carcinoma
Content Type	Text
Resource Type	Article
Subject	Dentistry
Journal Impact Factor	2.6/2023
5-Year Journal Impact Factor	3.2/2023

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