Regional Variation in Quality of Prostate Cancer Care

Overview

Journal J Urol

Publisher Wolters Kluwer

Specialty Urology

Date 2013 Oct 23

PMID 24144685

Citations 22

Authors

Florian R Schroeck

Samuel R Kaufman

Bruce L Jacobs

Ted A Skolarus

John M Hollingsworth

Vahakn B Shahinian

Brent K Hollenbeck

Affiliations

Soon will be listed here.

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.

Citing Articles

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References

Hofer T, Hayward R, Greenfield S, Wagner E, Kaplan S, Manning W . The unreliability of individual physician "report cards" for assessing the costs and quality of care of a chronic disease. JAMA. 1999; 281(22):2098-105. DOI: 10.1001/jama.281.22.2098. View

Diez Roux A, Merkin S, Arnett D, Chambless L, Massing M, Nieto F . Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001; 345(2):99-106. DOI: 10.1056/NEJM200107123450205. View

Warren J, Klabunde C, Schrag D, Bach P, Riley G . Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002; 40(8 Suppl):IV-3-18. DOI: 10.1097/01.MLR.0000020942.47004.03. View

Zingmond D, Ettner S, Wilber K, Wenger N . Association of claims-based quality of care measures with outcomes among community-dwelling vulnerable elders. Med Care. 2011; 49(6):553-9. PMC: 4535422. DOI: 10.1097/MLR.0b013e31820e5aab. View

Coburn N, Swallow C, Kiss A, Law C . Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer. 2006; 107(9):2143-51. DOI: 10.1002/cncr.22229. View

Li Z, Armstrong E, Amstrong E, Parker J, Danielsen B, Romano P . Hospital variation in readmission after coronary artery bypass surgery in California. Circ Cardiovasc Qual Outcomes. 2012; 5(5):729-37. DOI: 10.1161/CIRCOUTCOMES.112.966945. View

Finlayson E, Birkmeyer J . Research based on administrative data. Surgery. 2009; 145(6):610-6. DOI: 10.1016/j.surg.2009.03.005. View

Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P . A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006; 60(4):290-7. PMC: 2566165. DOI: 10.1136/jech.2004.029454. View

Malin J, Schneider E, Epstein A, Adams J, Emanuel E, Kahn K . Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States?. J Clin Oncol. 2006; 24(4):626-34. DOI: 10.1200/JCO.2005.03.3365. View

10.

Spencer B, Miller D, Litwin M, Ritchey J, Stewart A, Dunn R . Variations in quality of care for men with early-stage prostate cancer. J Clin Oncol. 2008; 26(22):3735-42. DOI: 10.1200/JCO.2007.13.2555. View

11.

Spencer B, Steinberg M, Malin J, Adams J, Litwin M . Quality-of-care indicators for early-stage prostate cancer. J Clin Oncol. 2003; 21(10):1928-36. DOI: 10.1200/JCO.2003.05.157. View

12.

Fowles J, Lawthers A, Weiner J, Garnick D, Petrie D, Palmer R . Agreement between physicians' office records and Medicare Part B claims data. Health Care Financ Rev. 1996; 16(4):189-99. PMC: 4193526. View

13.

McPherson K, WENNBERG J, Hovind O, Clifford P . Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982; 307(21):1310-4. DOI: 10.1056/NEJM198211183072104. View

14.

Merlo J, Yang M, Chaix B, Lynch J, Rastam L . A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people. J Epidemiol Community Health. 2005; 59(9):729-36. PMC: 1733145. DOI: 10.1136/jech.2004.023929. View

15.

Mariotto A, Yabroff K, Shao Y, Feuer E, Brown M . Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011; 103(2):117-28. PMC: 3107566. DOI: 10.1093/jnci/djq495. View

16.

Kahn K, Tisnado D, Adams J, Liu H, Chen W, Hu F . Does ambulatory process of care predict health-related quality of life outcomes for patients with chronic disease?. Health Serv Res. 2007; 42(1 Pt 1):63-83. PMC: 1955244. DOI: 10.1111/j.1475-6773.2006.00604.x. View

17.

Bilimoria K, Bentrem D, Stewart A, Winchester D, Ko C . Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Data Base. J Clin Oncol. 2009; 27(25):4177-81. DOI: 10.1200/JCO.2008.21.7018. View

18.

Radley D, Schoen C . Geographic variation in access to care--the relationship with quality. N Engl J Med. 2012; 367(1):3-6. DOI: 10.1056/NEJMp1204516. View

19.

Dimick J, Staiger D, Hall B, Ko C, Birkmeyer J . Composite measures for profiling hospitals on surgical morbidity. Ann Surg. 2012; 257(1):67-72. DOI: 10.1097/SLA.0b013e31827b6be6. View

20.

Zapka J, Taplin S, Ganz P, Grunfeld E, Sterba K . Multilevel factors affecting quality: examples from the cancer care continuum. J Natl Cancer Inst Monogr. 2012; 2012(44):11-9. PMC: 3482973. DOI: 10.1093/jncimonographs/lgs005. View