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. 2014 Apr;191(4):957-62.
doi: 10.1016/j.juro.2013.10.066. Epub 2013 Oct 19.

Regional variation in quality of prostate cancer care

Florian R Schroeck  1 , Samuel R Kaufman  2 , Bruce L Jacobs  1 , Ted A Skolarus  3 , John M Hollingsworth  2 , Vahakn B Shahinian  4 , Brent K Hollenbeck  5
Affiliations

Regional variation in quality of prostate cancer care

Florian R Schroeck et al. J Urol. 2014 Apr.

Abstract

Purpose: Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated regional variation in adherence to these quality measures to identify targets for future quality improvement.

Materials and methods: For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted regional adherence to the endorsed quality measures.

Results: Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition, there was considerable regional variation in adherence to several measures, including pretreatment counseling by a urologist and radiation oncologist (range 9% to 89%, p <0.001), avoiding overuse of bone scans in low risk cancer (range 16% to 96%, p <0.001), treatment by a high volume provider (range 1% to 90%, p <0.001) and followup with radiation oncologists (range 14% to 86%, p <0.001).

Conclusions: We found low adherence rates for most established prostate cancer quality of care measures. Within most measures regional variation in adherence was pronounced. Measures with low adherence and a large amount of regional variation may be important low hanging targets for quality improvement.

Keywords: health services research; prostatic neoplasms; quality improvement; quality of health care; small-area analysis.

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Figures

Figure 1
Figure 1
Variation in quality of prostate cancer care across 661 Hospital Service Areas (HSAs) located within the SEER areas. HSAs were ranked from lowest to highest adherence to each quality measure. The probability of receiving care adherent to each quality measure was calculated by use of hierarchical generalized linear modeling, adjusting for patient and regional characteristics. These models also account for differences in reliability of individual HSA-level adherence rates resulting from variations in the number of patients per HSA. The solid red line represents the adjusted adherence rate for each HSA. The horizontal line represents the adjusted overall mean rate of adherence. Error bars represent 95% confidence intervals for the rates of the individual HSAs. Black error bars represent rates that are statistically significantly different from the overall mean. Grey error bars represent rates that are not significantly different from the overall mean.
Figure 2
Figure 2
Proportion of HSAs that were high-performing for one quality measure and also high-performing (top 20%) for the other quality measures. * Denotes p<0.05 from chi square test.
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Comment in

  • Editorial comment.
    Resnick MJ. Resnick MJ. J Urol. 2014 Apr;191(4):962-3. doi: 10.1016/j.juro.2013.10.149. Epub 2013 Dec 25. J Urol. 2014. PMID: 24373693 No abstract available.

References

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