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.
MATERIALS AND METHODS: For this retrospective cohort study, we used Surveillance, Epidemiology, and End Results (SEER) -Medicare data for 2001-2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas [HSAs]). Hierarchical generalized linear models were used to examine reliability adjusted regional adherence to the endorsed quality measures.
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).
CONCLUSIONS: 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.
Written by:
Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Hollingsworth JM, Shahinian VB, Hollenbeck BK. Are you the author?
Division of Health Services Research, Department of Urology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109; Division of Urologic Oncology, Department of Urology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109.
Reference: J Urol. 2013 Oct 18. pii: S0022-5347(13)05683-8.
doi: 10.1016/j.juro.2013.10.066
PubMed Abstract
PMID: 24144685
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