PURPOSE: To assess the relationship between healthcare system performance on nationally endorsed prostate cancer quality of care measures and prostate cancer treatment outcomes.
METHODS: This is a retrospective cohort study including 48,050 men from Surveillance Epidemiology and End Results - Medicare linked data who were diagnosed with localized prostate cancer between 2004 and 2009 and followed through 2010. Based on a composite quality measure, we categorized the healthcare systems in which these men were treated into 1-star (bottom 20%), 2-star (middle 60%), and 3-star (top 20%) systems. We then examined the association of healthcare system-level quality of care with outcomes using multivariable logistic and Cox regression.
RESULTS: Patients who underwent prostatectomy in 3-star versus 1-star healthcare systems had a lower risk of perioperative complications (odds ratio 0.80, 95% confidence interval [CI] 0.64-1.00). However, these patients were more likely to undergo a procedure addressing treatment-related morbidity (e.g., 11.3% vs. 7.8% treated for sexual morbidity, p=0.043). Among patients undergoing radiotherapy, star-ranking was not associated with treatment-related morbidity. Among all patients, star-ranking was not significantly associated with all-cause mortality (Hazard Ratio [HR] 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20).
CONCLUSION: We found no consistent associations between healthcare system quality and outcomes, which questions how meaningful these measures ultimately are for patients. Thus, future studies should focus on the development of more discriminative quality measures.
Written by:
Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Miller DC, Montgomery JS, Weizer AZ, Hollenbeck BK. Are you the author?
Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI; Department of Urology, University of Pittsburgh School of Medicine, Pittburgh, PA; Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Reference: J Urol. 2014 Mar 25. pii: S0022-5347(14)03042-0.
doi: 10.1016/j.juro.2014.03.091
PubMed Abstract
PMID: 24681332
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