Nationwide implementation of a multifaceted tailored strategy to improve uptake of standardized structured reporting in pathology: an effect and process evaluation

Abstract

Background: Implementation strategies are aimed at improving guideline adherence. Both effect and process evaluations are conducted to provide insights into the success or failure of these strategies. In our study, we evaluate the nationwide implementation of standardized structured reporting (SSR) in pathology.

Methods: An interrupted time series analysis was conducted to evaluate the effect of a previously developed implementation strategy, which consisted of various digitally available elements, on SSR in pathology laboratories. A segmented regression analysis was performed to analyze the change in mean SSR percentages directly after the strategy introduction for pathology reporting and specific subcategories. In addition, we analyzed the change in trend in the weekly percentages after strategy introduction, also for subgroups of tumor groups, retrieval methods, and type of laboratory. The change in SSR use after the strategy introduction was determined for all pathology laboratories. We further conducted a process evaluation in which the exposure to the strategy elements was determined. Experiences of the users with all strategy elements and the remaining barriers and potential strategy elements were evaluated through an eSurvey. We also tested whether exposure to a specific element and a combination of elements resulted in a higher uptake of SSR after strategy introduction.

Results: There was a significant increase in an average use of SSR after the strategy introduction for reporting of gastrointestinal (p=.018) and urological (p=.003) oncological diagnoses. A significant increase was present for all oncological resections as a group (p=.007). Thirty-three out of 42 pathology laboratories increased SSR use after the strategy introduction. The "Feedback button", an option within the templates for SSR to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users, and effectiveness results showed that it increased average SSR use after the strategy introduction. Barriers were still present for SSR implementation.

Conclusions: Nationwide SSR implementation improved for specific tumor groups and retrieval methods. The next step will be to further improve the use of SSR and, simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can facilitate proper treatment decisions in oncology.

Keywords: Clinical practice guidelines; Effect evaluation; Guideline adherence; Healthcare quality improvement; Implementation; Information technology; Oncology; Process evaluation; Standardized structured reporting.

Fig. 1

Study design

Fig. 2

Timeline of the nationwide dissemination strategy of the tailored implementation strategy

Fig. 3

Trend in SSR use June 2020–November 2020 and June 2021–November 2021 for all pathology reporting and separately for resection reporting and biopsy reporting

Fig. 4

Trend in SSR use June 2020–November 2020 and June 2021–November for gastrointestinal, gynecological, and urological tumors

Fig. 5

A National SSR usage for the pre introduction and post introduction period for all gastrointestinal, gynecological, and urological tumor reporting. Each symbol and line indicates a separate laboratory. B National SSR usage for the pre-introduction and post-introduction period for gastrointestinal tumor reporting. Each symbol and line indicates a separate laboratory. C National SSR usage for the pre-introduction and post-introduction period for gynecological tumor reporting. Each symbol and line indicates a separate laboratory. D National SSR usage for the pre-introduction and post-introduction period for urological tumor reporting. Each symbol and line indicates a separate laboratory

Fig. 6

A National SSR usage for the pre-introduction and post-introduction period for biopsy reporting. Each symbol and line indicates a separate laboratory. B National SSR usage for the pre-introduction and post-introduction period for resection reporting. Each symbol and line indicates a separate laboratory

Fig. 7

A National SSR usage for the pre-introduction and post-introduction period for non-academic pathology laboratories. Each symbol and line indicates a separate laboratory. B National SSR usage for the pre-introduction and post-introduction period for academic pathology laboratories. Each symbol and line indicates a separate laboratory