1
|
Lee-Miller C, Montgomery KE, Evered J, Phelps K, Norslien K, Parkes A, Kwekkeboom K. A Midwest Stakeholder Evaluation of an Adolescent and Young Adult Cancer Survivor Needs Assessment Survey. J Adolesc Young Adult Oncol 2024; 13:123-131. [PMID: 37581596 DOI: 10.1089/jayao.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Purpose: Over 87,000 adolescents and young adults (AYAs) are diagnosed with cancer in the United States each year. Improvement in outcomes in the AYA population has lagged that of both younger and older patients. This decrement may be attributable to several factors, including insufficient supportive care services. Our team modified the Needs Assessment & Service Bridge (NA-SB) tool, utilizing an iterative approach with patient and clinician stakeholders to meet the needs of the AYA population at a large Midwestern Cancer Center. Methods: We recruited a 10-member AYA Advisory Board (AB) from our Cancer Center patients, and met five times over 9 months to discuss supportive care and the NA-SB. We recruited a multidisciplinary group of oncology clinicians to assess content validity and conducted interviews with nine clinician stakeholders to discuss implementation. Results: The AB generated a 59-item-modified NA-SB, retaining most of the original NA-SB items and adding several more. Five items with concerns for relevance and/or clarity were revised to create the final 58-item-modified NA-SB. Priorities for implementation were identified by AB and clinician stakeholders. Conclusions: The modified NA-SB thoroughly reflects supportive care needs of our Midwestern AYA cancer survivors. When implemented, the tool may facilitate patient-care team communication and provide data to prioritize development of new supportive care resources. AYA cancer survivors have unique supportive care needs that are insufficiently addressed by current care models; using the modified NA-SB may help address those needs, leading to improved AYA outcomes.
Collapse
Affiliation(s)
- Cathy Lee-Miller
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Jane Evered
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kat Phelps
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | | | - Amanda Parkes
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | |
Collapse
|
2
|
Maganty A, Kaufman SR, Oerline MK, Faraj K, Caram ME, Shahinian VB, Hollenbeck BK. Association Between Urologist Merit-Based Incentive Payment System Performance and Quality of Prostate Cancer Care. UROLOGY PRACTICE 2024; 11:207-214. [PMID: 37748132 PMCID: PMC10842494 DOI: 10.1097/upj.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION We performed a study to evaluate the association between urologist performance in the Merit-Based Incentive Payment System (MIPS), and quality and spending for prostate cancer care. METHODS Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019 were assigned to their primary urologist. Associated MIPS scores were identified and categorized based on thresholds for payment adjustment as low (worst), moderate, and high (best). Multivariable mixed effects models were used to measure the association between MIPS performance and adherence to quality measures and price standardized spending for prostate cancer. RESULTS Adherence to quality measures did not vary across MIPS performance groups for pretreatment counselling by both a urologist and radiation oncologist (low-76%, [95% CI 73%-80%], moderate-77% [95% CI 74%-79%], and high-75% [95% CI 74%-76%]) and avoiding treatment in men with a high risk of noncancer mortality within 10 years of diagnosis (low-40% [95% CI 35%-45%], moderate-39% [95% CI 36%-43%], high-38% [95% CI 36%-39%]). Men on active surveillance managed by high performers more likely received a confirmatory test (44% [95% CI 43%-46%]) compared to those managed by moderate (38% [95% CI 33%-42%]) performers, but not low performers (36% [95% CI 29%-44%]). There was no difference in adjusted spending across MIPS performance groups. CONCLUSIONS Better performance in MIPS is associated with a higher rate of confirmatory testing in men initiating active surveillance for prostate cancer. However, performance was not associated with other dimensions of quality nor spending.
Collapse
Affiliation(s)
- Avinash Maganty
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Samuel R. Kaufman
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Mary K. Oerline
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Kassem Faraj
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Megan E.V. Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Vahakn B. Shahinian
- University of Michigan, Department of Urology, Division of Health Services Research
- Division of Nephrology, Department of Internal Medicine, University of Michigan
| | | |
Collapse
|
3
|
Dotse-Gborgbortsi W, Tatem AJ, Matthews Z, Alegana V, Ofosu A, Wright J. Delineating natural catchment health districts with routinely collected health data from women's travel to give birth in Ghana. BMC Health Serv Res 2022; 22:772. [PMID: 35698112 PMCID: PMC9190150 DOI: 10.1186/s12913-022-08125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Health service areas are essential for planning, policy and managing public health interventions. In this study, we delineate health service areas from routinely collected health data as a robust geographic basis for presenting access to maternal care indicators. Methods A zone design algorithm was adapted to delineate health service areas through a cross-sectional, ecological study design. Health sub-districts were merged into health service areas such that patient flows across boundaries were minimised. Delineated zones and existing administrative boundaries were used to provide estimates of access to maternal health services. We analysed secondary data comprising routinely collected health records from 32,921 women attending 27 hospitals to give birth, spatial demographic data, a service provision assessment on the quality of maternal healthcare and health sub-district boundaries from Eastern Region, Ghana. Results Clear patterns of cross border movement to give birth emerged from the analysis, but more women originated closer to the hospitals. After merging the 250 sub-districts in 33 districts, 11 health service areas were created. The minimum percent of internal flows of women giving birth within any health service area was 97.4%. Because the newly delineated boundaries are more “natural” and sensitive to observed flow patterns, when we calculated areal indicator estimates, they showed a marked improvement over the existing administrative boundaries, with the inclusion of a hospital in every health service area. Conclusion Health planning can be improved by using routine health data to delineate natural catchment health districts. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.
Collapse
Affiliation(s)
- Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton, Southampton, S017 1BJ, UK. .,WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK.
| | - Andrew J Tatem
- School of Geography and Environmental Science, University of Southampton, Southampton, S017 1BJ, UK.,WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Zoë Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Victor Alegana
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Jim Wright
- School of Geography and Environmental Science, University of Southampton, Southampton, S017 1BJ, UK
| |
Collapse
|
4
|
Rege S, Coburn E, Robertson DJ, Calderwood AH. Practice Patterns and Predictors of Stopping Colonoscopy in Older Adults With Colorectal Polyps. Clin Gastroenterol Hepatol 2022; 20:e1050-e1060. [PMID: 34216826 PMCID: PMC8716643 DOI: 10.1016/j.cgh.2021.06.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Older adults with colorectal polyps undergo frequent surveillance colonoscopy. There is no specific guidance regarding when to stop surveillance. We aimed to characterize endoscopist recommendations regarding surveillance colonoscopy in older adults and identify patient, procedure, and endoscopist characteristics associated with recommendations to stop. METHODS This was a retrospective cohort study at a single academic medical center of adults aged ≥75 years who underwent colonoscopy for polyp surveillance or screening during which polyps were found. The primary outcome was a recommendation to stop surveillance. Predictors examined included patient age, sex, family history of colorectal cancer, polyp findings, and endoscopist sex and years in practice. Associations were evaluated using multilevel logistic regression. RESULTS Among 1426 colonoscopies performed by 17 endoscopists, 34.6% contained a recommendation to stop and 52.3% to continue. Older patients were more likely to receive a recommendation to stop, including those 80-84 years (odds ratio [OR], 7.7; 95% confidence interval [CI], 4.8-12.3) and ≥85 years (OR, 9.0; 95% CI, 3.3-24.6), compared with those 75-79 years. Family history of colorectal cancer (OR, 0.42; 95% CI, 0.24-0.74) and a history of low-risk (OR, 0.17; 95% CI, 0.11-0.24) or high-risk (OR, 0.02; 95% CI, 0.01-0.04) polyps were inversely associated with recommendations to stop. The likelihood of a recommendation to stop varied significantly across endoscopists. CONCLUSIONS Only 35% of adults ≥75 years of age are recommended to stop surveillance colonoscopy. The presence of polyps was strongly associated with fewer recommendations to stop. The variation in endoscopist recommendations highlights an opportunity to better standardize recommendations following colonoscopy in older adults.
Collapse
Affiliation(s)
- Soham Rege
- Dartmouth's Geisel School of Medicine, Hanover, New Hampshire
| | - Elliot Coburn
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Douglas J Robertson
- Dartmouth's Geisel School of Medicine, Hanover, New Hampshire; Veterans Affairs, White River Junction, Vermont
| | - Audrey H Calderwood
- Dartmouth's Geisel School of Medicine, Hanover, New Hampshire; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| |
Collapse
|
5
|
Research on Maternal Service Area and Referral System in Hubei Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084881. [PMID: 35457748 PMCID: PMC9027386 DOI: 10.3390/ijerph19084881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023]
Abstract
Hospital service area (HSA) and Hospital referral region (HRR) are significant in organizing maternal care resources in hierarchical medical systems. This quantitative study aims to delineate HAS and HRR by using obstetrics medical record data reflecting patients' medical behavior to improve the efficiency of the utilization of medical resources. The Dartmouth method and an improved version that considers the administrative division was applied to delineate HSA and HRR by using the obstetrics medical records in Hubei Province of China in 2016. The result shows that 117 Dartmouth HSAs have a strong correlation with the county boundaries and 22 Dartmouth HRRs are highly coincident with the prefecture boundaries in Hubei. In addition, 25 improved Dartmouth HRRs within prefecture boundaries and core areas serving patients across prefecture boundaries have been identified. Based on the above results, two sets of hierarchical healthcare systems were constructed, respectively, which can provide methods and references for delineating HAS and HRR in the hierarchical medical systems in other regions of China and developing countries. The findings of this study shed light on future research and policymaking in the spatial organization of medical resources for improving the efficiency and equity in maternal care delivery.
Collapse
|
6
|
Wang C, Wang F. GIS-Automated Delineation of Hospital Service Areas in Florida: From Dartmouth Method to Network Community Detection Methods. ANNALS OF GIS 2022; 28:93-109. [PMID: 35937312 PMCID: PMC9355116 DOI: 10.1080/19475683.2022.2026470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/01/2022] [Indexed: 06/02/2023]
Abstract
Since the Dartmouth hospital service areas (HSAs) were proposed three decades ago, there has been a large body of work using the unit in examining the geographic variation in health care in the U.S. for evaluating health care system performance and informing health policy. However, many studies question the replicability and reliability of the Dartmouth HSAs in meeting the challenges of ever-changing and a diverse set of health care services. This research develops a reproducible, automated, and efficient GIS tool to implement Dartmouth method for defining HSAs. Moreover, the research adapts two popular network community detection methods to account for spatial constraints for defining HSAs that are scale flexible and optimize an important property such as maximum service flows within HSAs. A case study based on the state inpatient database in Florida from the Healthcare Cost and Utilization Project is used to evaluate the efficiency and effectiveness of the methods. The study represents a major step toward developing HSA delineation methods that are computationally efficient, adaptable for various scales (from a local region to as large as a national market), and automated without a steep learning curve for public health professionals.
Collapse
|
7
|
McAllister BJ. Adherence to discharge protocols and prostate‐specific antigen surveillance plans in men without a prostate cancer diagnosis. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Leapman MS, Wang R, Park HS, Yu JB, Sprenkle PC, Dinan MA, Ma X, Gross CP. Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management. JAMA Netw Open 2021; 4:e2128646. [PMID: 34623406 PMCID: PMC8501394 DOI: 10.1001/jamanetworkopen.2021.28646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. OBJECTIVE To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercial insurance claims for prostate MRI and genomic testing included 65 530 patients 40 to 89 years of age newly diagnosed with prostate cancer from July 1, 2012, through June 30, 2019. EXPOSURES Patient- and regional-level use of prostate MRI and genomic testing. MAIN OUTCOMES AND MEASURES Observation vs definitive treatment for prostate cancer. Patient-level analyses examined the association between receipt of testing or residing in a hospital referral region (HRR) that adopted testing and observation. In regional-level analyses, the dependent variable was the change in the proportion of patients observed for prostate cancer at the HRR level between 2 periods: July 1, 2012, to June 30, 2014, and July 1, 2017, to June 20, 2019. The independent study variables included HRR-level changes in the proportion of men undergoing prostate MRI and genomic testing between these periods, and the models were adjusted for contextual factors associated with prostate cancer care and socioeconomic status. RESULTS This study identified 65 530 patients, including 27 679 in the early period (mean [SD] age, 58.0 [5.9] years) and 37 851 in the late period (mean [SD] age, 59.0 [5.7] years). Use of prostate MRI increased significantly from 7.2% (95% CI, 6.9%-7.5%) to 16.7% (95% CI, 16.3%-17.1%) from the early to late period. Use of genomic testing increased significantly from 1.3% (95% CI, 1.1%-1.4%) to 12.7% (95% CI, 12.3%-13.0%) from the early to late period. Compared with the lowest, the highest HRR quartiles of prostate MRI and genomic testing uptake were associated with an adjusted 4.1% (SE, 1.1%; P < .001) and 2.5% (SE, 1.1%; P = .03) absolute increase in the proportion of patients receiving observation, respectively. CONCLUSIONS AND RELEVANCE In this cohort study, uptake of prostate MRI and genomic testing was associated with increased use of initial observation vs treatment for prostate cancer. Marked geographic variation supports the need for further patient-level research to optimize the dissemination and outcome of testing.
Collapse
Affiliation(s)
- Michael S. Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Henry S. Park
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - James B. Yu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Michaela A. Dinan
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
9
|
Abstract
Objective To examine three aspects of urologist practice structure that may affect quality of prostate cancer care: practice size, ownership of an intensity modulated radiation therapy (IMRT) device, participation within a multi-specialty group (MSG). Health care reforms focused on improving quality are particularly relevant for prostate cancer given its prevalence and concerns for overdiagnosis and overtreatment. Methods Using data from the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked registry, we examined quality of prostate cancer treatment according to each treating urologist's practice size, type (single-specialty vs. MSG) and ownership of IMRT. Mixed models were used to adjust for patient differences. Results We identified 22,412 men with newly diagnosed prostate cancer treated by 2,199 urologists during the study. We observed minimal differences for most quality metrics according to practice size, type, and ownership of IMRT. Adherence to all eligible quality metrics was better among MSGs compared to single specialty groups (20.0% adherence versus 18.2%, p=0.01) whereas there was no significant difference by ownership of IMRT (17.1% adherence in owners versus 18.9% non-owners, p=0.09). Conclusion Differences in quality across practice size, type and ownership of IMRT were modest, with substantial room for improvement regardless of practice structure.
Collapse
|
10
|
Reitblat C, Bain PA, Porter ME, Bernstein DN, Feeley TW, Graefen M, Iyer S, Resnick MJ, Stimson CJ, Trinh QD, Gershman B. Value-Based Healthcare in Urology: A Collaborative Review. Eur Urol 2021; 79:571-585. [PMID: 33413970 DOI: 10.1016/j.eururo.2020.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and remunerated. OBJECTIVE To systematically review the literature regarding the implementation and impact of value-based healthcare in urology. EVIDENCE ACQUISITION A systematic review was performed to identify studies that described the implementation of one or more elements of value-based healthcare in urologic settings and in which the associated change in healthcare value had been measured. Twenty-two publications were selected for inclusion. EVIDENCE SYNTHESIS Reorganization of urologic care around medical conditions was associated with increased use of guidelines-compliant care for men with prostate cancer, and improved outcomes for patients with lower urinary tract symptoms. Measuring outcomes for every patient was associated with improved prostate cancer outcomes, while the measurement of costs using time-driven activity-based costing was associated with reduced resource utilization in a pediatric multidisciplinary clinic. Centralization of urologic cancer care in the UK, Denmark, and Canada was associated with overall improved outcomes, although systems integration in the USA yielded mixed results among urologic cancer patients. No studies have yet examined bundled payments for episodes of care, expanding the geographic reach for centers of excellence, or building enabling information technology platforms. CONCLUSIONS Few studies have critically assessed the actual or simulated implementation of value-based healthcare in urology, but the available literature suggests promising early results. In order to effectively redesign care, there is a need for further research to both evaluate the potential results of proposed value-based healthcare interventions and measure their effects where already implemented. PATIENT SUMMARY While few studies have evaluated the implementation of value-based healthcare in urology, the available literature suggests promising early results.
Collapse
Affiliation(s)
- Chanan Reitblat
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Business School, Boston, MA, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Michael E Porter
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - David N Bernstein
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA; Harvard Combined Orthopedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Markus Graefen
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA; Embold Health, Nashville, TN, USA
| | - C J Stimson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
11
|
Leapman MS, Wang R, Ma S, Gross CP, Ma X. Regional Adoption of Commercial Gene Expression Testing for Prostate Cancer. JAMA Oncol 2021; 7:52-58. [PMID: 33237277 DOI: 10.1001/jamaoncol.2020.6086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Although tissue-based genomic tests can aid in treatment decision-making for patients with prostate cancer, little is known about their clinical adoption. Objective To evaluate regional adoption of genomic testing for prostate cancer and understand common trajectories of uptake shared by regions. Design, Setting, and Participants This dynamic cohort study of patients diagnosed with prostate cancer used administrative claims from Blue Cross Blue Shield Axis, the largest source of commercial health insurance in the US, to characterize temporal trends in the use of commercial, tissue-based genomic testing and calculate the proportion of tested patients at the hospital referral region (HRR) level. Eligible patients from July 1, 2012, through June 30, 2018, were those aged 40 to 89 years with prostate cancer diagnosed from July 1, 2012, through June 30, 2018. Main Outcomes and Measures Group-based trajectory modeling was used to classify regions according to discrete trajectories of adoption of commercial, tissue-based genomic testing for prostate cancer. Across regions with distinct trajectories, HRR-level sociodemographic and health care contextual characteristics were compared, using data previously calculated among Medicare beneficiaries. Results A total of 92 418 men with prostate cancer who met inclusion criteria were identified; the median (interquartile range) age at diagnosis was 60 (56-63) years. Overall, the proportion of patients who received genomic testing increased from 0.8% in July 2012 to June 2013 to 11.3% in July 2017 to June 2018. Trajectory modeling identified 5 distinct regional trajectories of genomic testing adoption. Although less than 1% of patients in each group were tested at baseline, group 1 (lowest adoption) increased to 4.0%. Groups 2 (7.8%), 3 (14.6%), and 4 (17.3%) experienced more modest growth, while in group 5 (highest adoption), use increased to 33.8% of patients tested from June 2017 to July 2018. Compared with regions that more slowly adopted testing, HRRs with the highest rate of adoption (group 5) had higher HRR-level education measures (percentage [SD] with college education: group 1, 25.6% [4.8%]; vs group 2, 27.5% [7.3%]; vs group 3, 30.3% [9.1%]; vs group 4, 29.8% [8.2%]; vs group 5, 30.4% [11.4%]; P for trend = .03), median (SD) household income (group 1, $50 412.8 [$6907.4]; vs group 2, $54 419.6 [$11 324.5]; vs group 3, $61 424.0 [$17 723.8]; vs group 4, $58 508.3 [$15 174.6]; vs group 5, $58 367.0 [$13 180.5]; P for trend = .005), and prostate cancer resources, including clinician density (No. [SD] of clinicians per 100 000: group 1, 2.5 [0.3]; vs group 2, 2.5 [0.5]; vs group 3, 2.6 [0.5]; vs group 4, 2.7 [0.7]; vs group 5, 2.6 [0.5]; P for trend = .04) and prostate cancer screening (percentage [SD] of prostate-specific antigen testing among patients aged 68-74 y: group 1, 29.4% [11.8%]; vs group 2, 32.4% [11.2%]; vs group 3, 33.1% [12.7%]; vs group 4, 36.1% [9.7%]; vs group 5, 28.8% [11.8%]; P for trend = .05). Conclusions and Relevance In this cohort study of patients with prostate cancer, the adoption of commercial tissue-based genomic testing for prostate cancer was highly variable in the US at the regional level and may be associated with contextual measures related to socioeconomic status and patterns of prostate cancer care. These findings highlight factors underlying differential adoption of prognostic technologies for patients with cancer.
Collapse
Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
12
|
IJsbrandy C, Ottevanger PB, Gerritsen WR, van Harten WH, Hermens RPMG. Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study. J Cancer Surviv 2020; 15:163-177. [PMID: 32986232 PMCID: PMC7822788 DOI: 10.1007/s11764-020-00921-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
Collapse
Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands. .,Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. .,Department of Radiation Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, MB-HTSR, University of Twente, Enschede, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| |
Collapse
|
13
|
Lawson KA, Daignault K, Abouassaly R, Khanna A, Martin L, Goldenberg M, Hamilton RJ, Loblaw A, Warde P, Saarela O, Finelli A. Hospital-level Effects Contribute to Variations in Prostate Cancer Quality of Care. Eur Urol Oncol 2020; 4:494-497. [PMID: 32938571 DOI: 10.1016/j.euo.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/21/2020] [Indexed: 12/01/2022]
Abstract
A paucity of real-world data exists highlighting whether variations in prostate cancer quality of care occur at a hospital level, independent of differences in case mix. To overcome this knowledge gap, we benchmarked hospital-level quality (n = 1245 hospitals) across a broad multidisciplinary panel of previously reported disease-specific, expert-defined quality indicators (QIs), adjusting for differences in patient case mix by indirect standardization. A composite measure of prostate cancer quality-the prostate cancer quality score (PC-QS)-was derived, and associations between PC-QS and hospital volume, academic status, and location as well as patient all-cause mortality were determined. After adjusting for the case mix, of the total of 1245 hospitals evaluated, 2-37% were identified as those performing significantly below the national average for a given QI. Hospitals with a higher PC-QS displayed larger patient volumes, were more commonly academic affiliated, and had lower overall mortality. Collectively, our data-driven benchmarking analysis reveals that widespread hospital-level variations exist in prostate cancer quality of care after adjusting for differences in case mix, with the PC-QS serving as a novel, validated, quality benchmarking tool. PATIENT SUMMARY: Our statistical benchmarking method shows that the quality of prostate cancer care varies between hospitals, after accounting for differences in patient characteristics. The prostate cancer quality score is a novel, validated, quality benchmarking tool.
Collapse
Affiliation(s)
- Keith A Lawson
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Katherine Daignault
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Robert Abouassaly
- Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Abhinav Khanna
- Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Martin
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Mitchell Goldenberg
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
14
|
Cutumisu M, Vasquez C, Uhlich M, Beatty PH, Hamayeli-Mehrabani H, Djebah R, Murtha A, Greiner R, Lewis JD. PROSPeCT: A Predictive Research Online System for Prostate Cancer Tasks. JCO Clin Cancer Inform 2020; 3:1-12. [PMID: 31116569 DOI: 10.1200/cci.18.00144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE An online clinical information system, called Predictive Research Online System Prostate Cancer Tasks (PROSPeCT), was developed to enable users to query the Alberta Prostate Cancer Registry database hosted by the Alberta Prostate Cancer Research Initiative. To deliver high-quality patient treatment, prostate cancer clinicians and researchers require a user-friendly system that offers an easy and efficient way to obtain relevant and accurate information about patients from a robust and expanding database. METHODS PROSPeCT was designed and implemented to make it easy for users to query the prostate cancer patient database by creating, saving, and reusing simple and complex definitions. We describe its intuitive nature by exemplifying the creation and use of a complex definition to identify a "high-risk" patient cohort. RESULTS PROSPeCT was made to minimize user error and to maximize efficiency without requiring the user to have programming skills. Thus, it provides tools that allow both novice and expert users to easily identify patient cohorts, manage individual patient care, perform Kaplan Meier estimates, plot aggregate PSA views, compute PSA-doubling time, and visualize results. CONCLUSION This report provides an overview of PROSPeCT, a system that helps clinicians to identify appropriate patient treatments and researchers to develop prostate cancer hypotheses, with the overarching goal of improving the quality of life of patients with prostate cancer. We have made available the code for the PROSPeCT implementation at https://github.com/max-uhlich/e-PROSPeCT .
Collapse
Affiliation(s)
| | | | | | | | | | - Rume Djebah
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - John D Lewis
- University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
15
|
Haynes AG, Wertli MM, Aujesky D. Automated delineation of hospital service areas as a new tool for health care planning. Health Serv Res 2020; 55:469-475. [PMID: 32078171 DOI: 10.1111/1475-6773.13275] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To develop an automated, reproducible method for delineating hospital service areas (HSAs). DATA SOURCES/SETTING Discharge data from all Swiss acute care hospitals for the years 2013 to 2016. STUDY DESIGN We derived HSAs and hospital referral regions for Switzerland using a newly developed flow-based, automated, objective, and reproducible method using all discharge data. We compared our method to the classical, partially subjective approach used to delineate the Swiss Health Care Atlas by delineating four sets of intervention-specific HSAs. PRINCIPAL FINDINGS Based on 4 105 885 discharges, the fully automated method delineated 63 HSAs. Comparison with existing HSAs reveals good overlap and comparable measures of health utilization between the methods and shows that in the Swiss setting, our method outperforms a cluster-based approach to defining HSAs. While the classical method potentially takes an entire day to delineate the regions, our method took approximately 10 minutes. CONCLUSIONS Hospital service areas are used to analyze differences in use of health care that may indicate underuse and overuse. Our new, fully automated, objective, and reproducible method provides a useful tool for hospital services researchers that will enable them to delineate and update patient-flow-based HSAs.
Collapse
Affiliation(s)
| | - Maria M Wertli
- Division of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Division of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
The Role of Provider Characteristics in the Selection of Surgery or Radiation for Localized Prostate Cancer and Association With Quality of Care Indicators. Am J Clin Oncol 2018; 41:1076-1082. [PMID: 29668486 DOI: 10.1097/coc.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We sought to identify the role of provider and facility characteristics in receipt of radical prostatectomy (RP) or external beam radiation therapy (EBRT) and adherence to quality of care measures in men with localized prostate cancer (PCa). MATERIALS AND METHODS Subjects included 2861 and 1630 men treated with RP or EBRT, respectively, for localized PCa whose records were reabstracted as part of the Centers for Disease Control and Prevention Breast and Prostate Patterns of Care Study. We utilized multivariable generalized estimating equation regression analysis to assess patient, clinical, and provider (year of graduation, urologist density) and facility (group vs. solo, academic/teaching status, for-profit status, distance to treatment facility) characteristics that predicted use of RP versus EBRT as well as quality of care outcomes. RESULTS Multivariable analysis revealed that group (vs. solo) practice was associated with a decreased risk of RP (odds ratio, 0.47; 95% confidence interval, 0.25-0.91). Among RP patients with low-risk disease, receipt of a bone scan that was not recommended was significantly predicted by race and insurance status. Surgical quality of care measures were associated with physician's year of graduation and receiving care at a teaching facility. CONCLUSIONS In addition to demographic factors, we found that provider and facility characteristics were associated with treatment choice and specific quality of care measures. Long-term follow-up is required to determine whether quality of care indicators are related to PCa outcomes.
Collapse
|
17
|
Utilization of Prostate Cancer Quality Metrics for Research and Quality Improvement: A Structured Review. Jt Comm J Qual Patient Saf 2018; 45:217-226. [PMID: 30236510 DOI: 10.1016/j.jcjq.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The shift toward value-based care in the United States emphasizes the role of quality measures in payment models. Many diseases, such as prostate cancer, have a proliferation of quality measures, resulting in resource burden and physician burnout. This study aimed to identify and summarize proposed prostate cancer quality measures and describe their frequency and use in peer-reviewed literature. METHODS The PubMed database was used to identify quality measures relevant to prostate cancer care, and included articles in English through April 2018. A gray literature search for other documents was also conducted. After the selection process of the pertinent articles, measure characteristics were abstracted, and uses were summarized for the 10 most frequently utilized measures in the literature. RESULTS A total of 26 articles were identified for review. Of the 71 proposed prostate cancer quality measures, only 47 were used, and less than 10% of these were endorsed by the National Quality Forum. Process measures were most frequently reported (84.5%). Only 6 outcome measures (8.5%) were proposed-none of which were among the most frequently utilized. CONCLUSION Although a high number of proposed prostate cancer quality measures are reported in the literature, few were assessed, and the majority of these were non-endorsed process measures. Process measures were most commonly assessed; outcome measures were rarely evaluated. In a step to close the quality chasm, a "top 5" core set of quality measures for prostate cancer care, including structure, process, and outcomes measures, is suggested. Future studies should consider this comprehensive set of quality measures.
Collapse
|
18
|
Sampurno F, Zheng J, Di Stefano L, Millar JL, Foster C, Fuedea F, Higano C, Huland H, Mark S, Moore C, Richardson A, Sullivan F, Wenger NS, Wittmann D, Evans S. Quality Indicators for Global Benchmarking of Localized Prostate Cancer Management. J Urol 2018; 200:319-326. [DOI: 10.1016/j.juro.2018.02.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Fanny Sampurno
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jia Zheng
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lydia Di Stefano
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L. Millar
- William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton and University Hospital Southampton, Southampton and Urology, London, United Kingdom
| | - Ferran Fuedea
- Radiation Oncology Department, Institut Català d'Oncologia, Radiation Oncology, Barcelona University and Radiobiology and Cancer Group, Bellvitge Biochemical Research Institute, Barcelona, Spain
| | - Celestia Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hartwig Huland
- Martini-Klinik, Prostate Cancer Centre, University Hamburg, Hamburg, Germany
| | - Stephen Mark
- Department of Urology, Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Caroline Moore
- Division of Surgical and Interventional Science, University College London, London, United Kingdom
| | - Alison Richardson
- Cancer Nursing and End of Life Care, Faculty of Health Sciences, University of Southampton and University Hospital Southampton, Southampton and Urology, London, United Kingdom
| | - Frank Sullivan
- Prostate Cancer Institute, National University of Ireland Galway and Department of Radiation Oncology, Galway Clinic, Galway, Ireland
| | - Neil S. Wenger
- Division of General Internal Medicine, University of California-Los Angeles, Los Angeles, California
| | - Daniela Wittmann
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Kantor O, Wang CH, Yao K. Regional Variation in Performance for Commission on Cancer Breast Quality Measures and Impact on Overall Survival. Ann Surg Oncol 2018; 25:3069-3075. [PMID: 29956092 DOI: 10.1245/s10434-018-6592-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Adherence to quality measures has become an important indicator of cancer center performance for high-quality cancer care. We examined regional variation in performance for Commission on Cancer breast quality measures and its impact on overall survival (OS) for those measures that have been shown to impact OS. METHODS Six breast quality measures were analyzed using the National Cancer Data Base from 2014 to 2015, and a multivariable model was used to assess performance for each measure by region. Kaplan-Meier and Cox proportional hazard models were used to examine OS between high- and low-performing centers from 2007 to 2012. RESULTS Overall, 305,391 women had surgery at 1322 institutions in nine US regions; 90.8% underwent needle biopsy (range 86.0-92.6% between regions, p < 0.01), 69.8% had breast-conserving surgery (BCS) for stage 0-II cancer (60.9-79.3%, p < 0.01), 85.2% aged < 70 years had radiation therapy (RT) after BCS (79.6-90.8%, p < 0.01), 78.3% of women with four or more positive nodes had post-mastectomy RT (70.9-84.5%, p < 0.01), 90.9% with hormone receptor (HR)-positive stage IB-III cancer had hormone therapy (83.7-95.1%, p < 0.01), and 89.4% aged < 70 years with HR-negative stage IB-III cancer had chemotherapy (87.6-91.4%, p < 0.01). Multivariate analyses adjusted for patient and facility factors found that region was the only consistent predictor of non-compliance across measures. With median 65-month follow-up, there was no difference in OS between high- and low-performing centers for the three measures that have been shown to impact OS. CONCLUSIONS There is significant regional variation in performance on the breast quality measures but this variation did not impact OS. Targeted efforts in certain areas of the country may help improve performance on these measures.
Collapse
Affiliation(s)
- Olga Kantor
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Chi-Hsiung Wang
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Katharine Yao
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. .,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
20
|
Filson CP. Quality of care and economic considerations of active surveillance of men with prostate cancer. Transl Androl Urol 2018; 7:203-213. [PMID: 29732278 PMCID: PMC5911536 DOI: 10.21037/tau.2017.08.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.
Collapse
Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta Veterans Administration Medical Center, Decatur, GA, USA
| |
Collapse
|
21
|
Evans SM, Millar JL, Moore CM, Lewis JD, Huland H, Sampurno F, Connor SE, Villanti P, Litwin MS. Cohort profile: the TrueNTH Global Registry - an international registry to monitor and improve localised prostate cancer health outcomes. BMJ Open 2017; 7:e017006. [PMID: 29183925 PMCID: PMC5719323 DOI: 10.1136/bmjopen-2017-017006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Globally, prostate cancer treatment and outcomes for men vary according to where they live, their race and the care they receive. The TrueNTH Global Registry project was established as an international registry monitoring care provided to men with localised prostate cancer (CaP). PARTICIPANTS Sites with existing CaP databases in Movember fundraising countries were invited to participate in the international registry. In total, 25 Local Data Centres (LDCs) representing 113 participating sites across 13 countries have nominated to contribute to the project. It will collect a dataset based on the International Consortium for Health Outcome Measures (ICHOM) standardised dataset for localised CaP. FINDINGS TO DATE A governance strategy has been developed to oversee registry operation, including transmission of reversibly anonymised data. LDCs are represented on the Project Steering Committee, reporting to an Executive Committee. A Project Coordination Centre and Data Coordination Centre (DCC) have been established. A project was undertaken to compare existing datasets, understand capacity at project commencement (baseline) to collect the ICHOM dataset and assist in determining the final data dictionary. 21/25 LDCs provided data dictionaries for review. Some ICHOM data fields were well collected (diagnosis, treatment start dates) and others poorly collected (complications, comorbidities). 17/94 (18%) ICHOM data fields were relegated to non-mandatory fields due to poor capture by most existing registries. Participating sites will transmit data through a web interface biannually to the DCC. FUTURE PLANS Recruitment to the TrueNTH Global Registry-PCOR project will commence in late 2017 with sites progressively contributing reversibly anonymised data following ethical review in local regions. Researchers will have capacity to source deidentified data after the establishment phase. Quality indicators are to be established through a modified Delphi approach in later 2017, and it is anticipated that reports on performance against quality indicators will be provided to LDCs.
Collapse
Affiliation(s)
- Sue M Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- William Buckland Radiotherapy Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Caroline M Moore
- Department of Urology, Division of Surgical and Interventional Science, University College London, London, UK
| | - John D Lewis
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Hartwig Huland
- Universitatsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Fanny Sampurno
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Paul Villanti
- Movember Foundation, East Melbourne, Victoria, Australia
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, USA
| |
Collapse
|
22
|
Friedlander DF, Trinh QD, Krasnova A, Lipsitz SR, Sun M, Nguyen PL, Kibel AS, Choueiri TK, Weissman JS, Menon M, Abdollah F. Racial Disparity in Delivering Definitive Therapy for Intermediate/High-risk Localized Prostate Cancer: The Impact of Facility Features and Socioeconomic Characteristics. Eur Urol 2017; 73:445-451. [PMID: 28778619 DOI: 10.1016/j.eururo.2017.07.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 07/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races. OBJECTIVE To examine facility level variation in the use of definitive therapy among Black and White men for localized PCa. DESIGN, SETTING, AND PARTICIPANTS Using data from the National Cancer Data Base, we identified 223 873 White and 59 262 Black men ≥40 yr of age receiving care within the USA with biopsy confirmed localized intermediate/high-risk PCa diagnosed between January 2004 and December 2013. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multilevel logistic regression was fitted to predict the odds of receiving definitive therapy for PCa. Sensitivity and subgroup analyses were performed to adjust for inherent patient and facility-level differences when appropriate. RESULTS AND LIMITATIONS Eighty-three percent (n=185 647) of White men received definitive therapy compared with 74% (n=43 662) of Black men between 2004 and 2013. Overall rates of definitive therapy during that time increased for both White (81% vs 83%, p<0.001) and Black (73% vs 75%, p=0.001) men. However, 39% of treating facilities demonstrated significantly higher rates of definitive therapy in White men, compared with just 1% favoring Black men. Our study is limited by potential selection bias and effect modification. CONCLUSIONS After adjusting for sociodemographic and clinical factors, we found that most facilities favored definitive therapy in Whites. Health care providers should be aware of these inherit biases when counseling patients on treatment options for localized PCa. Our study is limited by the retrospective nature of the cohort. PATIENT SUMMARY We found significant differences in rates of radiation and surgical treatment for prostate cancer among White and Black men, with most facilities favoring Whites. Nonclinical factors such as treatment facility type and location influenced rates of therapy.
Collapse
Affiliation(s)
- David F Friedlander
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Anna Krasnova
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxine Sun
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul L Nguyen
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Adam S Kibel
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
23
|
Abstract
BACKGROUND Overuse, the provision of health services for which harms outweigh the benefits, results in suboptimal patient care and may contribute to the rising costs of cancer care. We performed a systematic review of the evidence on overuse in oncology. METHODS We searched Medline, EMBASE, the Cochrane Library, Web of Science, SCOPUS databases, and 2 grey literature sources, for articles published between December 1, 2011 and March 10, 2017. We included publications from December 2011 to evaluate the literature since the inception of the ABIM Foundation's Choosing Wisely initiative in 2012. We included original research articles quantifying overuse of any medical service in patients with a cancer diagnosis when utilizing an acceptable standard to define care appropriateness, excluding studies of cancer screening. One of 4 investigator reviewed titles and abstracts and 2 of 4 reviewed each full-text article and extracted data. Methodology used PRISMA guidelines. RESULTS We identified 59 articles measuring overuse of 154 services related to imaging, procedures, and therapeutics in cancer management. The majority of studies addressed adult or geriatric patients (98%) and focused on US populations (76%); the most studied services were diagnostic imaging in low-risk prostate and breast cancer. Few studies evaluated active cancer therapeutics or interventions aimed at reducing overuse. Rates of overuse varied widely among services and among studies of the same service. CONCLUSIONS Despite recent attention to overuse in cancer, evidence identifying areas of overuse remains limited. Broader investigation, including assessment of active cancer treatment, is critical for identifying improvement targets to optimize value in cancer care.
Collapse
|
24
|
Kolhe NV, Fluck RJ, Muirhead AW, Taal MW. Regional Variation in Acute Kidney Injury Requiring Dialysis in the English National Health Service from 2000 to 2015 - A National Epidemiological Study. PLoS One 2016; 11:e0162856. [PMID: 27749903 PMCID: PMC5066970 DOI: 10.1371/journal.pone.0162856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/13/2016] [Indexed: 12/19/2022] Open
Abstract
Background The absence of effective interventions in presence of increasing national incidence and case-fatality in acute kidney injury requiring dialysis (AKI-D) warrants a study of regional variation to explore any potential for improvement. We therefore studied regional variation in the epidemiology of AKI-D in English National Health Service over a period of 15 years. Method We analysed Hospital Episode Statistics data for all patients with a diagnosis of AKI-D, using ICD-10-CM codes, in English regions between 2000 and 2015 to study temporal changes in regional incidence and case-fatality. Results Of 203,758,879 completed discharges between 1st April 2000 and 31st March 2015, we identified 54,252 patients who had AKI-D in the nine regions of England. The population incidence of AKI-D increased variably in all regions over 15 years; however, the regional variation decreased from 3·3-fold to 1·3-fold (p<0·01). In a multivariable adjusted model, using London as the reference, in the period of 2000–2005, the North East (odd ratio (OR) 1·38; 95%CI 1·01, 1·90), East Midlands (OR 1·38; 95%CI 1·01, 1·90) and West Midlands (OR 1·38; 95%CI 1·01, 1·90) had higher odds for death, while East of England had lower odds for death (OR 0·66; 95% CI 0·49, 0·90). The North East had higher OR in all three five-year periods as compared to the other eight regions. Adjusted case-fatality showed significant variability with temporary improvement in some regions but overall there was no significant improvement in any region over 15 years. Conclusions We observed considerable regional variation in the epidemiology of AKI-D that was not entirely attributable to variations in demographic or other identifiable clinical factors. These observations make a compelling case for further research to elucidate the reasons and identify interventions to reduce the incidence and case-fatality in all regions.
Collapse
Affiliation(s)
- Nitin V. Kolhe
- Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom
- * E-mail:
| | - Richard J. Fluck
- Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom
| | - Andrew W. Muirhead
- Department of Public Health, Derby City Council, Corporation Street, Derby, DE1 2FS, United Kingdom
| | - Maarten W. Taal
- Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby, DE22 3NE, United Kingdom
| |
Collapse
|
25
|
Holmes JA, Bensen JT, Mohler JL, Song L, Mishel MH, Chen RC. Quality of care received and patient-reported regret in prostate cancer: Analysis of a population-based prospective cohort. Cancer 2016; 123:138-143. [DOI: 10.1002/cncr.30315] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan A. Holmes
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jeannette T. Bensen
- Department of Epidemiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
| | - James L. Mohler
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
- Department of Urology; Roswell Park Cancer Institute; Buffalo New York
| | - Lixin Song
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Merle H. Mishel
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ronald C. Chen
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
- Sheps Center for Health Services Research; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| |
Collapse
|
26
|
Herrel LA, Kaufman SR, Yan P, Miller DC, Schroeck FR, Skolarus TA, Shahinian VB, Hollenbeck BK. Health Care Integration and Quality among Men with Prostate Cancer. J Urol 2016; 197:55-60. [PMID: 27423758 DOI: 10.1016/j.juro.2016.07.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The delivery of high quality prostate cancer care is increasingly important for health systems, physicians and patients. Integrated delivery systems may have the greatest ability to deliver high quality, efficient care. We sought to understand the association between health care integration and quality of prostate cancer care. MATERIALS AND METHODS We used SEER-Medicare data to perform a retrospective cohort study of men older than age 65 with prostate cancer diagnosed between 2007 and 2011. We defined integration within a health care market based on the number of discharges from a top 100 integrated delivery system, and compared rates of adherence to well accepted prostate cancer quality measures in markets with no integration vs full integration (greater than 90% of discharges from an integrated system). RESULTS The average man treated in a fully integrated market was more likely to receive pretreatment counseling by a urologist and radiation oncologist (62.6% vs 60.3%, p=0.03), avoid inappropriate imaging (72.2% avoided vs 60.6%, p <0.001), avoid treatment when life expectancy was less than 10 years (23.7% vs 17.3%, p <0.001) and avoid multiple hospitalizations in the last 30 days of life (50.2% vs 43.6%, p=0.001) than when treated in markets with no integration. Additionally, patients treated in fully integrated markets were more likely to have complete adherence to all eligible quality measures (OR 1.38, 95% CI 1.27-1.50). CONCLUSIONS Integrated systems are associated with improved adherence to several prostate cancer quality measures. Expansion of the integrated health care model may facilitate greater delivery of high quality prostate cancer care.
Collapse
Affiliation(s)
- Lindsey A Herrel
- Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Samuel R Kaufman
- Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Phyllis Yan
- Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Florian R Schroeck
- White River Junction VA Medical Center, White River Junction, Vermont, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ted A Skolarus
- Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Vahakn B Shahinian
- Kidney Epidemiology Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
27
|
Schmid M, Meyer CP, Reznor G, Choueiri TK, Hanske J, Sammon JD, Abdollah F, Chun FKH, Kibel AS, Tucker-Seeley RD, Kantoff PW, Lipsitz SR, Menon M, Nguyen PL, Trinh QD. Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer. JAMA Oncol 2016; 2:85-93. [PMID: 26502115 DOI: 10.1001/jamaoncol.2015.3384] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE There is extensive evidence suggesting that black men with localized prostate cancer (PCa) have worse cancer-specific mortality compared with their non-Hispanic white counterparts. OBJECTIVE To evaluate racial disparities in the use, quality of care, and outcomes of radical prostatectomy (RP) in elderly men (≥ 65 years) with nonmetastatic PCa. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis of outcomes stratified according to race (black vs non-Hispanic white) included 2020 elderly black patients (7.6%) and 24,462 elderly non-Hispanic white patients (92.4%) with localized PCa who underwent RP within the first year of PCa diagnosis in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2009. The study was performed in 2014. MAIN OUTCOMES AND MEASURES Process of care (ie, time to treatment, lymph node dissection), as well as outcome measures (ie, complications, emergency department visits, readmissions, PCa-specific and all-cause mortality, costs) were evaluated using Cox proportional hazards regression. Multivariable conditional logistic regression and quantile regression were used to study the association of racial disparities with process of care and outcome measures. RESULTS The proportion of black patients with localized prostate cancer who underwent RP within 90 days was 59.4% vs 69.5% of non-Hispanic white patients (P < 001). In quantile regression of the top 50% of patients, blacks had a 7-day treatment delay compared with non-Hispanic whites. (P < 001). Black patients were less likely to undergo lymph node dissection (odds ratio [OR], 0.76 [95% CI, 0.66-0.80]; P < .001) but had higher odds of postoperative visits to the emergency department (within 30 days: OR, 1.48 [95% CI, 1.18-1.86]); after 30 days or more (OR, 1.45 [95% CI, 1.19-1.76]) and readmissions (within 30 days: OR, 1.28 [95% CI, 1.02-1.61]); ≥ 30 days (OR, 1.27 [95% CI, 1.07-1.51]) compared with non-Hispanic whites. The surgical treatment of black patients was associated with a higher incremental annual cost (the top 50% of blacks spent $1185.50 (95% CI , $804.85-1 $1566.10; P < .001) more than the top 50% of non-Hispanic whites). There was no difference in PCa-specific mortality (P = .16) or all-cause mortality (P = .64) between black and non-Hispanic white men. CONCLUSIONS AND RELEVANCE Blacks treated with RP for localized PCa are more likely to experience adverse events and incur higher costs compared with non-Hispanic white men; however, this does not translate into a difference in PCa-specific or all-cause mortality.
Collapse
Affiliation(s)
- Marianne Schmid
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gally Reznor
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julian Hanske
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Kibel
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reginald D Tucker-Seeley
- Center for Community-Based Research, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip W Kantoff
- Dana-Farber Cancer Institute, Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Paul L Nguyen
- Dana-Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
28
|
Gandaglia G, Bray F, Cooperberg MR, Karnes RJ, Leveridge MJ, Moretti K, Murphy DG, Penson DF, Miller DC. Prostate Cancer Registries: Current Status and Future Directions. Eur Urol 2016; 69:998-1012. [PMID: 26056070 DOI: 10.1016/j.eururo.2015.05.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/26/2015] [Indexed: 01/08/2023]
Abstract
CONTEXT Disease-specific registries that enroll a considerable number of patients play a major role in prostate cancer (PCa) research. OBJECTIVE To evaluate available registries, describe their strengths and limitations, and discuss the potential future role of PCa registries in outcomes research. EVIDENCE ACQUISITION We performed a literature review of the Medline, Embase, and Web of Science databases. The search strategy included the terms prostate cancer, outcomes, statistical approaches, population-based cohorts, registries of outcomes, and epidemiological studies, alone or in combination. We limited our search to studies published between January 2005 and January 2015. EVIDENCE SYNTHESIS Several population-based and prospective disease-specific registries are currently available for prostate cancer. Studies performed using these data sources provide important information on incidence and mortality, disease characteristics at presentation, risk factors, trends in utilization of health care services, disparities in access to treatment, quality of care, long-term oncologic and health-related quality of life outcomes, and costs associated with management of the disease. Although data from these registries have some limitations, statistical methods are available that can address certain biases and increase the internal and external validity of such analyses. In the future, improvements in data quality, collection of tissue samples, and the availability of data feedback to health care providers will increase the relevance of studies built on population-based and disease-specific registries. CONCLUSIONS The strengths and limitations of PCa registries should be carefully considered when planning studies using these databases. Although randomized controlled trials still provide the highest level of evidence, large registries play an important and growing role in advancing PCa research and care. PATIENT SUMMARY Several population-based and prospective disease-specific registries for prostate cancer are currently available. Analyses of data from these registries yield information that is clinically relevant for the management of patients with prostate cancer.
Collapse
Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Department of Oncology, San Raffaele Hospital, Milan, Italy.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Matthew R Cooperberg
- Departments of Urology and Epidemiology & Biostatistics, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | | | - Kim Moretti
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Repatriation General Hospital, Daw Park, and the University of South Australia and the University of Adelaide, South Australia, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University, and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
| | - David C Miller
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
29
|
Craft PS. Improving quality in prostate cancer. Med J Aust 2016; 204:290. [DOI: 10.5694/mja16.00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/26/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Paul S Craft
- The Canberra Hospital, Canberra, ACT
- Australian National University, Canberra, ACT
| |
Collapse
|
30
|
Zeidan AM, Wang R, Davidoff AJ, Ma S, Zhao Y, Gore SD, Gross CP, Ma X. Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes. Cancer 2016; 122:1598-607. [PMID: 26970288 DOI: 10.1002/cncr.29945] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although newer treatments for myelodysplastic syndromes (MDS), particularly hypomethylating agents (HMAs), are expensive, it is unclear whether MDS-related costs of care are associated with overall survival. This study evaluated the relation between MDS-related costs and survival among Medicare beneficiaries with MDS. METHODS Eligible patients were identified from the Surveillance, Epidemiology, and End Results-Medicare database with codes for MDS from International Classification of Diseases for Oncology, 3rd edition. The patients were diagnosed between January 1, 2005 and December 31, 2011, were 66 years old or older, and were followed through death or the end of study (December 31, 2012). Medicare payments were used to estimate costs. Cumulative costs in a propensity score-matched group of cancer-free Medicare beneficiaries were subtracted from costs in the MDS cohort in each registry to estimate MDS-related costs. Hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from multivariate Cox proportional hazards models adjusted for patient and disease characteristics. RESULTS There were 8580 eligible patients, and 1,267 (14.7%) received HMAs. The overall 2-year survival rate was 48.7%, and the 2-year registry-specific MDS-related cost per patient ranged from $40,793 to $78,156 across 16 registries. The 2-year MDS-related cost was not associated with survival in the overall study population (first tertile, reference; second tertile, HR, 0.96; 95% CI, 0.89-1.04; P = .29; third tertile, HR, 0.98; 95% CI, 0.91-1.06; P = .64) or in subgroups of patients who did or did not receive HMAs. CONCLUSIONS Medicare expenditures for elderly patients with MDS varied across registries but were not associated with survival. A lack of an association between costs and outcomes warrants additional research because it may help to identify potential areas for cost-saving interventions without compromising patient outcomes. Cancer 2016;122:1598-607. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Amer M Zeidan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Amy J Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Yinjun Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Steven D Gore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
31
|
Divi V, Ma Y, Rhoads KF. Regional variation in head and neck cancer mortality: Role of patient and hospital characteristics. Head Neck 2015; 38 Suppl 1:E1896-902. [DOI: 10.1002/hed.24343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/07/2015] [Accepted: 10/17/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Vasu Divi
- Department of Otolaryngology, Division of Head and Neck Surgery; Stanford University; Palo Alto California
| | - Yifei Ma
- Department of Surgery Stanford Cancer Institute; Stanford University; Palo Alto California
| | - Kim F. Rhoads
- Department of Surgery Stanford Cancer Institute; Stanford University; Palo Alto California
| |
Collapse
|
32
|
Stienen JJC, Hermens RPMG, Wennekes L, van de Schans SAM, van der Maazen RWM, Dekker HM, Liefers J, van Krieken JHJM, Blijlevens NMA, Ottevanger PB. Variation in guideline adherence in non-Hodgkin's lymphoma care: impact of patient and hospital characteristics. BMC Cancer 2015; 15:578. [PMID: 26253203 PMCID: PMC4529707 DOI: 10.1186/s12885-015-1547-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 07/14/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin's lymphoma (NHL) care. METHODS Validated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data. RESULTS Data of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain. Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner. CONCLUSION Fifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice.
Collapse
Affiliation(s)
- Jozette J C Stienen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Lianne Wennekes
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Saskia A M van de Schans
- Netherlands Comprehensive Cancer Organisation, Department of Registry and Research, PO box 19079, 3501 DB, Utrecht, the Netherlands.
| | | | - Helena M Dekker
- Department of Radiology, Radboud university medical center, Nijmegen, the Netherlands.
| | - Janine Liefers
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | | | - Nicole M A Blijlevens
- Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud university medical center, Nijmegen, the Netherlands.
| |
Collapse
|
33
|
Scott E. Androgen Deprivation With or Without Radiation Therapy for Clinically Node-Positive Prostate Cancer. ACTA ACUST UNITED AC 2015; 107:djv119. [PMID: 28159496 DOI: 10.1093/jnci/djv119] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 04/03/2015] [Indexed: 12/16/2022]
|
34
|
Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Zhang Y, Hollenbeck BK. Technology diffusion and prostate cancer quality of care. Urology 2014; 84:1066-72. [PMID: 25443905 DOI: 10.1016/j.urology.2014.06.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/10/2014] [Accepted: 06/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association of technological capacity with prostate cancer quality of care. Technological capacity was conceptualized as a market's ability to provide prostate cancer treatment with new technology, including robotic prostatectomy and intensity-modulated radiotherapy (IMRT). METHODS In this retrospective cohort study, we used data from the Surveillance, Epidemiology, and End Results-Medicare linked database from 2004 to 2009 to identify men with newly diagnosed prostate cancer (n = 46,274). We measured technological capacity as the number of providers performing robotic prostatectomy or IMRT per population in a health care market. We used multilevel logistic regression analysis to assess the association of technological capacity with receiving quality care according to a set of nationally endorsed quality measures, while adjusting for patient and market characteristics. RESULTS Overall, our findings were mixed with only subtle differences in quality of care comparing high-tech with low-tech markets. High robotic prostatectomy capacity was associated with better adherence to some quality measures, such as avoiding unnecessary bone scans (79.8% vs 73.0%; P = .003) and having follow-up with urologists (67.7% vs 62.6%; P = .023). However, for most measures, neither high robotic prostatectomy nor high-IMRT capacity was associated with significant increases in adherence rates. In fact, for 1 measure (treatment by a high-volume provider), high-IMRT capacity was associated with lower performance (23.4% vs 28.5%; P <.001). CONCLUSION Our findings suggest that new technology is not clearly associated with higher quality of care. To improve quality, more specific efforts will be needed.
Collapse
Affiliation(s)
- Florian R Schroeck
- 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
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ted A Skolarus
- 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; Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Yun Zhang
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Brent K Hollenbeck
- 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.
| |
Collapse
|
35
|
Receipt of best care according to current quality of care measures and outcomes in men with prostate cancer. J Urol 2014; 193:500-4. [PMID: 25108275 DOI: 10.1016/j.juro.2014.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated whether patients with prostate cancer who received best care according to a set of 5 nationally endorsed quality measures had decreased treatment related morbidity and improved cancer control. MATERIALS AND METHODS In this retrospective cohort study we included 38,055 men from the SEER (Surveillance, Epidemiology and End Results)-Medicare database treated for localized prostate cancer between 2004 and 2010. We determined whether each patient received best care, defined as care adherent to all applicable measures. We measured associations of best care with the need for interventions, addressing treatment related morbidity, and with the need for secondary cancer therapy using Cox proportional hazards models. RESULTS Only 3,412 men (9.0%) received best care. Five years after treatment these men and men who did not receive best care had a similar likelihood of undergoing procedures for urinary morbidity (prostatectomy subset 10.7% vs 12.9%, p = 0.338) and secondary cancer therapy (prostatectomy for high risk prostate cancer subset 40.9% vs 37.3%, p = 0.522). However, they were more likely to be treated with a procedure for sexual morbidity (prostatectomy 17.3% vs 10.8%, p <0.001). Similar trends were observed in men treated with radiotherapy. CONCLUSIONS Overall men who received best care did not fare better in regard to treatment related morbidity or cancer control. Collectively our findings suggest that the current process of care measures are not tightly linked to outcomes and further research is needed to identify better measures that are meaningful and important to patients.
Collapse
|
36
|
Affiliation(s)
- Matthew E Nielsen
- Departments of Urology, Epidemiology, and Health Policy & Management, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| |
Collapse
|
37
|
Steers WD. This Month in Adult Urology. J Urol 2014. [DOI: 10.1016/j.juro.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Adherence to performance measures and outcomes among men treated for prostate cancer. J Urol 2014; 192:743-8. [PMID: 24681332 DOI: 10.1016/j.juro.2014.03.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE We assessed the relationship between health care system performance on nationally endorsed prostate cancer quality of care measures and prostate cancer treatment outcomes. MATERIALS AND METHODS This retrospective cohort study included 48,050 men from SEER-Medicare linked data diagnosed with localized prostate cancer between 2004 and 2009, and followed through 2010. Based on a composite quality measure we categorized the health care 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 health care system level quality of care with outcomes using multivariable logistic and Cox regression. RESULTS Patients who underwent prostatectomy in 3-star vs 1-star health care systems were at lower risk for perioperative complications (OR 0.80, 95% CI 0.64-1.00). However, they were more likely to undergo a procedure addressing treatment related morbidity, eg for sexual morbidity (11.3% vs 7.8%, p = 0.043). In patients who received radiotherapy star ranking was not associated with treatment related morbidity. In all patients star ranking was not significantly associated with all-cause mortality (HR 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20). CONCLUSIONS We found no consistent association between health care system quality and outcomes, which questions how meaningful these measures ultimately are for patients. Thus, future studies should focus on developing more discriminative quality measures.
Collapse
|