Impact Of Electronic Decision Support And Targeted Educational Intervention To Increase Adherence With Asco Choosing Wisely Breast Cancer Staging Guideline.

e18826 Background: ASCO Choosing Wisely recommends against ordering PET, CT, or bone scan as part of the initial staging workup for patients with early stage breast cancer. We implemented a two-step quality improvement intervention to increase adherence with this guideline. Methods: During a 4-month educational run-in period (from 07/2015 to 10/2015), we visited each of our medical oncology care centers and academic breast oncology team to discuss the ASCO Choosing Wisely breast cancer imaging recommendations. On 1/1/16, we turned on an electronic decision support reminder (best practice advisory or BPA) in our electronic health record (EHR). To assess impact, we compared imaging ordered for stage I/II breast cancer patients who did not receive neoadjuvant therapy and were treated in the Smilow Cancer Hospital/Yale Cancer Center health system during a pre-intervention (diagnosed 7/1/14-6/30/15) and post-intervention period (diagnosed 1/1/16-12/31/16). Cancer stage was obtained through the Yale Tumor Registry, and imaging utilization was measured for each patient during the 90-day period following diagnostic biopsy. Results: We identified 748 women in the pre- and 764 women in the post-intervention period with stage I/II breast cancer. After the intervention, the average number of scans ordered per patient among patients for whom imaging was ordered decreased from 1.92 (SD 0.97) to 1.70 (SD 0.71), p = 0.049. The average number of CTs ordered for patients for whom at least one CT was ordered decreased from 1.24 (SD 0.61) to 1.05 (0.22), p = 0.005. The percentage of patients for whom at least one advanced imaging test was ordered decreased from 17.2% to 13.7%. This decrease approached but did not achieve statistical significance, p = 0.060. Conclusions: We implemented a health system wide intervention using provider education and an electronic decision support tool to reduce advanced imaging during evaluation of early stage breast cancer. The intervention was acceptable to providers, and the post-intervention period had a trend towards less imaging utilization. Future work will aim to identify and address the main barriers to adopting Choosing Wisely guidelines.