ideasIdea
Real-time guideline-concordance feedback for every cancer centre
Show each hospital, every month, how often its patients received the recommended treatment, compared with peers, so gaps are seen and closed.
Audit and feedback is one of the best-evidenced ways to change clinical practice, but oncology audits are infrequent and slow. Using structured data (mCODE) and computable guidelines, concordance for key decisions (biomarker testing before first-line therapy, adjuvant therapy in eligible patients, guideline-recommended regimens) can be computed monthly per centre and fed back with peer comparison. Precedents include ASCO's QOPI and the Dutch cancer audits (DICA).
Hypothesis
Monthly automated feedback will close the gap between actual and recommended care for measured decisions by at least half within two years, particularly for biomarker testing rates.
Rationale
Cochrane reviews find audit and feedback improves adherence by a median of several percentage points, more when frequent and with peer comparison; automation removes the cost barrier to frequency.
What would test it
Randomise 40 centres to monthly automated feedback or annual audit; measure biomarker testing and guideline-concordant first-line therapy rates at 18 months.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks
- Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.