Practice- vs Physician-Level Variation in Use of Active Surveillance for Men With Low-Risk Prostate Cancer: Implications for Collaborative Quality Improvement

Abstract

This study examines the proportion of men treated primarily with active surveillance across practices and among urologists in the Michigan Urological Surgery Improvement Collaborative.

Figure 1.. Variation in Adjusted Rates of Active Surveillance (AS) for Men With Low-Risk Prostate Cancer by Practice (Bars) and by Urologist Within Each Practice (Dots)

Median patient age was 64 years; median prostate-specific antigen level was 5.0 ng/mL; and Charlson comorbidity score was 0 for 1868 men, 1 for 415 men, and 2 or higher for 360 men. Adjusted AS rates for each urologist and practice were estimated using a multivariable logistic regression model fit to account for differences in patient age and comorbidity among urologists. In the model, age was a continuous predictor, and Charlson comorbidity was a categorical predictor (categories = 0, 1, and ≥2). We defined low-risk according to criteria from the National Comprehensive Cancer Network (ie, clinical stage ≤T2a, prostate-specific antigen <10 ng/mL, and biopsy Gleason score ≤6). The number of urologists per practice varies from 5 to 38. The size of each dot is scaled to represent individual clinician panel size (range, 5-141).

Figure 2.. Relationship Between Urologist Panel Size and Percentage of Men Enrolled on Active Surveillance (AS) Within the Evaluated 4.5-Year Period^a

^aUrologist panel size = number of men with National Comprehensive Cancer Network low-risk prostate cancer a given urologist primarily treated.