Pd48-04 Does Enhanced Audit and Feedback With Education Improve Quality Indicator (Qi) Achievement and Reduce Early Recurrence Rates in Turbt Surgery for Nmibc? Results From the Resect Cluster Randomised Trial

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD48)1 May 2024PD48-04 DOES ENHANCED AUDIT AND FEEDBACK WITH EDUCATION IMPROVE QUALITY INDICATOR (QI) ACHIEVEMENT AND REDUCE EARLY RECURRENCE RATES IN TURBT SURGERY FOR NMIBC? RESULTS FROM THE RESECT CLUSTER RANDOMISED TRIAL Fortis Gaba, Kevin Gallagher, Nikita Bhatt, Keiran Clement, Eleanor Zimmermann, Sinan Khadhouri, Meghana Kulkarni, Thines Anbarasan, Alexander Ng, Alexander Light, Aqua Asif, Vinson Chan, Arjun Nathan, Sabrina Rossi, Wendy Geng, David Cooper, Lorna Aucott, Tim O'Brien, Steven MacLennan, Matthew Nielsen, Paramananthan Mariappan, and Veeru Kasivisvanathan Fortis GabaFortis Gaba , Kevin GallagherKevin Gallagher , Nikita BhattNikita Bhatt , Keiran ClementKeiran Clement , Eleanor ZimmermannEleanor Zimmermann , Sinan KhadhouriSinan Khadhouri , Meghana KulkarniMeghana Kulkarni , Thines AnbarasanThines Anbarasan , Alexander NgAlexander Ng , Alexander LightAlexander Light , Aqua AsifAqua Asif , Vinson ChanVinson Chan , Arjun NathanArjun Nathan , Sabrina RossiSabrina Rossi , Wendy GengWendy Geng , David CooperDavid Cooper , Lorna AucottLorna Aucott , Tim O'BrienTim O'Brien , Steven MacLennanSteven MacLennan , Matthew NielsenMatthew Nielsen , Paramananthan MariappanParamananthan Mariappan , and Veeru KasivisvanathanVeeru Kasivisvanathan View All Author Informationhttps://doi.org/10.1097/01.JU.0001008712.53259.7d.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to determine if feedback and education improves TURBT QIs and early recurrence rate. METHODS: This is an international, multi-centre observational study with an embedded cluster randomised trial of an institution-targeted performance feedback and educational tool (intervention) vs standard of care (no performance feedback)(control). Globally, any site performing TURBT surgery for NMIBC was eligible. Baseline retrospective data were collected on consecutive TURBTs and then sites were randomised to performance feedback, education, and access to operative pro-forma, or to standard clinical care. Data were then collected prospectively on consecutive TURBTs after randomisation. There were 4 co-primary outcomes (site level), adjusted for baseline achievement (rate of detrusor muscle sampling (DM+), rate of single instillation intravesical chemotherapy administration (SI-IVC+), rate of resection completeness documentation (RES-DOC) and rate of key tumour feature documentation (TUMF-DOC)). As a secondary outcome, the rate of recurrence at the first cystoscopy after complete TURBT was assessed at the patient level after adjustment for surgeon, site (random effects) and tumour number, size, grade and stage (fixed effects). Sites were excluded if they did not submit data for at least 20 eligible cases in both phases. Local and/or national approvals were obtained to run the study at each site including either ethical exemption or approval. RESULTS: 219 sites were randomised between 05/10/21 and 15/03/23 collecting data on 15,879 patients undergoing TURBT. After 18 exclusions (9 intervention, 9 control), 201 sites were included in the primary outcome analysis (Intervention: 100, Control: 101). Arms were comparable for patient, tumour, and site level variables. Sites having feedback and education had significantly greater achievement of both documentation outcomes (Adjusted mean difference (95% CI), RES-DOC: 5.6%(1.6,9.6) p=0.006; TUMF-DOC: 6.1%(1.8,10.3) p=0.005). There was no difference in SI-IVC+, DM+ or early recurrence rate. Of note, in the control arm, the early recurrence rate was significantly lower in the prospective phase vs the retrospective phase after adjusting for tumour size, number, grade and stage (Recurrence rate retrospective: 679/2748 (24.7%) vs prospective: 415/2245 (18.5%), Adjusted difference -5.5% (-7.7%,-3.2%), p-value <0.001, relative difference, 25%). CONCLUSIONS: Enhanced audit and feedback with education on TURBT performance improves documentation quality indicators, but not detrusor muscle sampling or SI-IVC in this setting. There was evidence that taking part in a global study of TURBT practice resulted in significant reduction in recurrence rates even in those without the intervention. This study would support the conduct of organised audits of TURBT practice. Source of Funding: medac Pharma, Karl Storz, Photocure © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e988 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Fortis Gaba More articles by this author Kevin Gallagher More articles by this author Nikita Bhatt More articles by this author Keiran Clement More articles by this author Eleanor Zimmermann More articles by this author Sinan Khadhouri More articles by this author Meghana Kulkarni More articles by this author Thines Anbarasan More articles by this author Alexander Ng More articles by this author Alexander Light More articles by this author Aqua Asif More articles by this author Vinson Chan More articles by this author Arjun Nathan More articles by this author Sabrina Rossi More articles by this author Wendy Geng More articles by this author David Cooper More articles by this author Lorna Aucott More articles by this author Tim O'Brien More articles by this author Steven MacLennan More articles by this author Matthew Nielsen More articles by this author Paramananthan Mariappan More articles by this author Veeru Kasivisvanathan More articles by this author Expand All Advertisement PDF downloadLoading ...