对于非脊柱骨转移患者，短程放疗（RT）可以在不牺牲临床获益的情况下减轻患者负担。然而，不同实践环境中短程放疗的采用情况存在很大差异。 评估一组 3 种实施策略是否有助于增加采用短程放疗治疗非脊柱骨转移瘤的共识建议（即≤5 次）这项前瞻性、阶梯式楔形、整群随机质量改进研究是在现有学术界合作伙伴关系内的 3 个社区癌症中心进行的。 2021 年 10 月至 2022 年 5 月期间，以 3 个月的增量开始推出。参与者包括治疗医生和接受非脊柱骨转移放疗的患者。数据分析于2022年10月至2023年5月进行。三种实施策略-(1)传播已发布的共识指南，(2)个性化审核和反馈报告，以及(3)基于电子邮件的电子咨询平台(eConsult)-主要结果是遵守针对非脊柱骨转移的短程放疗的共识建议。骨转移水平的混合效应逻辑回归用于模拟医生接触策略集（实施前与实施后）与短程放疗之间的关联，同时考虑患者和医生的特征以及日历时间，并使用随机变量对医生的作用。在实施之前和实施之后进行了医生调查，以评估每种策略的可行性、可接受性和适当性。45 名医生治疗了 714 名患者（治疗开始时的中位 [IQR] 年龄为 67 [59-75] 岁；343 名女性 [48 %]）在研究期间有 838 个独特的非脊柱骨转移。实施这组策略与短程放疗的使用无关（比值比，0.78；95% CI，0.45-1.34；P = .40），实施前未经调整的依从率为 53%（444 个病灶），而实施前为 56% （469 个病变）实施后；然而，调整后的坚持几率随着日历时间的增加而增加（优势比，1.68；95% CI，1.20-2.36；P = .003）。所有 3 项实施策略均被认为是可行的、可接受的且适当的；只有对审核和反馈适当性的看法在实施前后发生了变化（29 名医生中的 19 名 [66%] vs 30 名医生中的 27 名 [90%]；P = .03，Fisher 精确检验），其中 20 名医生（67%） ）更喜欢每季度报告一次。在这项质量改进研究中，一套多组成部分的实施策略与学术界伙伴关系中短期课程 RT 的使用增加无关。然而，实践随着时间的推移而改进，这可能是由于长期趋势或医生对这项研究的认识。审核和反馈比预期更合适。研究结果支持需要调查促进跨环境循证辐射实践的最佳方法。

For patients with nonspine bone metastases, short-course radiotherapy (RT) can reduce patient burden without sacrificing clinical benefit. However, there is great variation in uptake of short-course RT across practice settings.To evaluate whether a set of 3 implementation strategies facilitates increased adoption of a consensus recommendation to treat nonspine bone metastases with short-course RT (ie, ≤5 fractions).This prospective, stepped-wedge, cluster randomized quality improvement study was conducted at 3 community-based cancer centers within an existing academic-community partnership. Rollout was initiated in 3-month increments between October 2021 and May 2022. Participants included treating physicians and patients receiving RT for nonspine bone metastases. Data analysis was performed from October 2022 to May 2023.Three implementation strategies-(1) dissemination of published consensus guidelines, (2) personalized audit-and-feedback reports, and (3) an email-based electronic consultation platform (eConsult)-were rolled out to physicians.The primary outcome was adherence to the consensus recommendation of short-course RT for nonspine bone metastases. Mixed-effects logistic regression at the bone metastasis level was used to model associations between the exposure of physicians to the set of strategies (preimplementation vs postimplementation) and short-course RT, while accounting for patient and physician characteristics and calendar time, with a random effect for physician. Physician surveys were administered before implementation and after implementation to assess feasibility, acceptability, and appropriateness of each strategy.Forty-five physicians treated 714 patients (median [IQR] age at treatment start, 67 [59-75] years; 343 women [48%]) with 838 unique nonspine bone metastases during the study period. Implementing the set of strategies was not associated with use of short-course RT (odds ratio, 0.78; 95% CI, 0.45-1.34; P = .40), with unadjusted adherence rates of 53% (444 lesions) preimplementation vs 56% (469 lesions) postimplementation; however, the adjusted odds of adherence increased with calendar time (odds ratio, 1.68; 95% CI, 1.20-2.36; P = .003). All 3 implementation strategies were perceived as being feasible, acceptable, and appropriate; only the perception of audit-and-feedback appropriateness changed before vs after implementation (19 of 29 physicians [66%] vs 27 of 30 physicians [90%]; P = .03, Fisher exact test), with 20 physicians (67%) preferring reports quarterly.In this quality improvement study, a multicomponent set of implementation strategies was not associated with increased use of short-course RT within an academic-community partnership. However, practice improved with time, perhaps owing to secular trends or physician awareness of the study. Audit-and-feedback was more appropriate than anticipated. Findings support the need to investigate optimal approaches for promoting evidence-based radiation practice across settings.