Florian R Schroeck1, Samuel R Kaufman2, Bruce L Jacobs1, Ted A Skolarus3, John M Hollingsworth2, Vahakn B Shahinian4, Brent K Hollenbeck5. 1. Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan. 2. Division of Health Services Research, University of Michigan, Ann Arbor, Michigan. 3. Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan; HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan. 4. Department of Medicine, University of Michigan, Ann Arbor, Michigan. 5. Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: bhollen@med.umich.edu.
Abstract
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 to identify targets for future quality improvement. MATERIALS AND METHODS: For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). 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. In addition, there was considerable regional variation in adherence to several measures, including pretreatment counseling by 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 followup 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.
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 to identify targets for future quality improvement. MATERIALS AND METHODS: For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). 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. In addition, there was considerable regional variation in adherence to several measures, including pretreatment counseling by 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 followup 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.
Authors: A V Diez Roux; S S Merkin; D Arnett; L Chambless; M Massing; F J Nieto; P Sorlie; M Szklo; H A Tyroler; R L Watson Journal: N Engl J Med Date: 2001-07-12 Impact factor: 91.245
Authors: Zhongmin Li; Ehrin J Armstrong; Ehrin J Amstrong; Joseph P Parker; Beate Danielsen; Patrick S Romano Journal: Circ Cardiovasc Qual Outcomes Date: 2012-09-04
Authors: Florian R Schroeck; Samuel R Kaufman; Bruce L Jacobs; Ted A Skolarus; David C Miller; Jeffrey S Montgomery; Alon Z Weizer; Brent K Hollenbeck Journal: J Urol Date: 2014-03-25 Impact factor: 7.450
Authors: Shrujal S Baxi; Minal Kale; Salomeh Keyhani; Benjamin R Roman; Annie Yang; Antonio P Derosa; Deborah Korenstein Journal: Med Care Date: 2017-07 Impact factor: 2.983
Authors: Davide Gori; Rajendra Dulal; Douglas W Blayney; James D Brooks; Maria P Fantini; Kathryn M McDonald; Tina Hernandez-Boussard Journal: Jt Comm J Qual Patient Saf Date: 2018-09-18
Authors: Raj Satkunasivam; Mary Lo; Mariana Stern; Inderbir S Gill; Steven Fleming; Xiao-Cheng Wu; Roger T Anderson; Trevor D Thompson; Ann S Hamilton Journal: Am J Clin Oncol Date: 2018-11 Impact factor: 2.339
Authors: Florian R Schroeck; Samuel R Kaufman; Bruce L Jacobs; Ted A Skolarus; Yun Zhang; Brent K Hollenbeck Journal: Urology Date: 2014-10-24 Impact factor: 2.649
Authors: Amer M Zeidan; Rong Wang; Amy J Davidoff; Shuangge Ma; Yinjun Zhao; Steven D Gore; Cary P Gross; Xiaomei Ma Journal: Cancer Date: 2016-03-11 Impact factor: 6.860
Authors: Lindsey A Herrel; Samuel R Kaufman; Phyllis Yan; David C Miller; Florian R Schroeck; Ted A Skolarus; Vahakn B Shahinian; Brent K Hollenbeck Journal: J Urol Date: 2016-07-15 Impact factor: 7.450
Authors: Marianne Schmid; Christian P Meyer; Gally Reznor; Toni K Choueiri; Julian Hanske; Jesse D Sammon; Firas Abdollah; Felix K H Chun; Adam S Kibel; Reginald D Tucker-Seeley; Philip W Kantoff; Stuart R Lipsitz; Mani Menon; Paul L Nguyen; Quoc-Dien Trinh Journal: JAMA Oncol Date: 2016-01 Impact factor: 31.777