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A Multimodal Intervention to Increase Total Mesorectal Excision Grading for Rectal Cancer in Michigan: A Randomized
Joceline V Vu1, Arielle Kanters2, Mariana Berho3
1Department of Surgery, Temple University, Philadelphia, Pennsylvania.
Diseases of the Colon and Rectum
|February 28, 2025
Summary
A multimodal intervention aimed to increase total mesorectal excision grading for rectal cancer. However, grading rates increased statewide before the intervention, highlighting the need to account for secular trends in quality improvement studies.
Area of Science:
- Colorectal Surgery
- Surgical Quality Improvement
- Oncology
Background:
- Total mesorectal excision (TME) is crucial for rectal cancer outcomes.
- Grading TME specimens is recommended but implementation varies.
- A multimodal intervention was designed to boost TME grading rates in Michigan.
Purpose of the Study:
- To evaluate the impact of a multimodal intervention on TME grading rates.
- To compare grading rates between early and late intervention groups over time.
Main Methods:
- Stepped-wedge randomized controlled trial involving 12 hospitals.
- Hospitals were randomized to receive the intervention early or 1 year later.
- Generalized linear mixed models analyzed TME grading rates, adjusting for hospital characteristics.
Main Results:
- 560 patients undergoing TME between 2014-2021 were included.
- TME grading increased significantly in both early (8.1% to 99.7%) and late (47.8% to 94.0%) intervention groups.
- The observed increase in grading preceded the intervention, correlating with a statewide presentation in December 2016.
Conclusions:
- The multimodal intervention's effect on TME grading was confounded by a concurrent statewide quality improvement initiative.
- Hospitals participating in quality improvement collaboratives may exhibit pre-existing commitment to high-quality care, introducing selection bias.
- Findings underscore the importance of considering secular trends when evaluating healthcare quality improvement interventions.
