Quality-of-Care Indicators for Early-Stage Prostate Cancer

Spencer, Benjamin A.; Steinberg, Michael; Malin, Jennifer; Adams, John; Litwin, Mark S.

doi:10.1200/jco.2003.05.157

Cited by 119 publications

(119 citation statements)

References 50 publications

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“…15 Prior studies have observed that patients choosing surgery over other modalities, or robotic-assisted over open surgery, may later express regret over their decisions. 16,17 For localized prostate cancer, for which there is no optimal treatment and morbidities differ, promoting access to multiple providers holds the potential for enhancing the informed decision-making process, framing appropriate expectations, reducing treatment regret, and thereby improving post-treatment quality of life.…”

Section: Expectant Managementmentioning

confidence: 99%

Prostate cancer treatment for economically disadvantaged men

Parsons

Kwan

Connor

et al. 2010

Cancer

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BACKGROUND. The authors compared the types of treatments prostate cancer patients received from county hospitals and private providers as part of a statewide public assistance program. METHODS. This was a cohort study of 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling, and Treatment for Californians With Prostate Cancer (IMPACT). Multinomial regression was used to compare types of treatments patients received from different providers. RESULTS. Between 2001 and 2006, 315 (56%) participants received treatment from county hospitals and 244 (44%) from private providers. There were no significant betweengroup differences with respect to age (P ¼ .22), enrollment year (P ¼ .49), Charlson comorbidity index (P ¼ .47), Gleason sum (P ¼ .33), clinical T stage (P ¼ .36), prostate-specific antigen (P ¼ .39), or D'Amico risk criteria (P ¼ .45). Participants treated by private providers were more likely than those treated in county hospitals to be white (35% vs 10%, P < .01) and less likely to undergo surgery (29% vs 54%, P < .01). Multinomial regression analyses showed that participants treated by private providers were nearly 2 1 =2 times more likely than those treated by public providers to receive radiotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.37-4.07) and >4 1 =2 times more likely to receive primary androgen deprivation (OR, 4.71; 95% CI, 2.15-10.36) than surgery. CONCLUSIONS. In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers. These data reveal substantial variations in treatment patterns between different types of healthcare institutions that-given the implications for health policy and quality of care-merit further scrutiny. Cancer 2010;116:1378-84.

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Section: Expectant Managementmentioning

confidence: 99%

Prostate cancer treatment for economically disadvantaged men

Parsons

Kwan

Connor

et al. 2010

Cancer

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“…They are relatively easy and inexpensive to assess, but tend to be only weakly associated with outcomes, and are often difficult for providers to influence. Structural measures often work best at establishing a minimal threshold for quality-for example, suggesting that radiation therapy for prostate cancer should be provided at centers with access to intensity modulated delivery systems [6]-thus distinguishing good from inferior but not good from superior. One structural aspect of health care delivery that is the subject of much ongoing debate in urologic oncology and across multiple other fields in medicine is the extent to which hospital and clinician case volume predict outcomes, which will be discussed in more detail below and elsewhere in this seminar [7].…”

Section: Assessing Qualitymentioning

confidence: 99%

“…One appealing framework applicable to the latter situation is the National Surgical Quality Improvement Program (NSQIP) developed by the Department of Veterans Affairs (VA) [17] and recently extended to non-VA hospitals [18]. Spencer et al, likewise, have developed a set of quality indicators specific to surgical and radiation-based treatment of localized prostate cancer, which incorporates a mix of structure, process, and outcomes measures [6].…”

Section: Assessing Qualitymentioning

confidence: 99%

Defining high quality health care

Cooperberg

Birkmeyer

Litwin

2009

Urologic Oncology: Seminars and Original Investigations

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Most health care quality improvement efforts target measures of health care structures, processes, and/or outcomes. Structural measures examine relatively fixed aspects of health care delivery such as physical plant and human resources. Process measures, the focus of the largest proportion of quality improvement efforts, assess specific transactions in clinical-patient encounters, such as use of appropriate surgical antibiotic prophylaxis, which are expected to improve outcomes. Outcome measures, which comprise quality of life endpoints as well as morbidity and mortality, are of greatest interest to clinicians and patients, but entail the greatest complexity, as the majority of variance in outcomes is attributable to patient and environmental factors that may not be readily modifiable. Selecting among structure, process, and outcome measures for quality improvement efforts generally will be dictated by the specific clinical situation for which improvement is desired.One aspect of health care quality that has received a great deal of attention in recent years is the relationship between surgical volume and health outcomes. Volume, an inherent characteristic of a health care facility or provider, is generally considered a structural measure of quality. Many studies have demonstrated a positive association between volume and outcomes, and policymakers in the private and public sectors have begun to consider volume in certification and reimbursement decisions. The volume-outcome association is not without controversy, however. Most studies in the field are limited by the nature of the administrative data on which they are based, and some studies have found that variation in quality within volume quantiles exceeds differences between quantiles. Moreover, regionalization driven by a focus on volume may exert adverse effects on access to care.The movement for health care quality improvement faces substantial methodological, clinical, financial, and political challenges. Despite these challenges, it is a movement that is gaining momentum, and the emphasis on quality in health care delivery is likely only to increase in the future. It is crucial, therefore, that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care.

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“…This was done most comprehensively in 2000 by RAND. 2 More recently, the Physician Consortium for Performance Improvement (PCPI) and the National Quality Forum (NQF) endorsed several quality measures, incorporating some of the RAND measures and an up-to-date evidence base. 3,4 Three of these measures have also been included into the Centers for Medicare and Medicaid Services' Physician Quality Reporting System.…”

Section: Introductionmentioning

confidence: 99%

424 Regional Variation in the Quality of Prostate Cancer Care

et al. 2013

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Purpose-Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated regional variation in adherence to these quality measures in order to identify targets for future quality improvement. Results-Adherence at the patient level was highly variable, ranging from 33% for treatment by a high-volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high-risk cancer. Additionally, there was considerable regional variation in adherence to several measures, including pretreatment counseling by both a urologist and radiation oncologist (range 9% to 89%, p<0.001), avoiding overuse of bone scans in low-risk cancer (range 16% to 96%, p<0.001), treatment by a high-volume provider (range 1% to 90%, p<0.001), and follow-up with radiation oncologists (range 14% to 86%, p<0.001). Materials and Methods-ForConclusions-We found low adherence rates for most established prostate cancer quality of care measures. Within most measures, regional variation in adherence was pronounced. Measures with low adherence and a large amount of regional variation may be important low-hanging targets for quality improvement.

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Quality-of-Care Indicators for Early-Stage Prostate Cancer

Cited by 119 publications

References 50 publications

Prostate cancer treatment for economically disadvantaged men

Prostate cancer treatment for economically disadvantaged men

Defining high quality health care

424 Regional Variation in the Quality of Prostate Cancer Care

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