PD12-03 IMPACT OF ADHERENCE TO QUALITY MEASURES FOR LOCALIZED PROSTATE CANCER ON HEALTH-RELATED QUALITY OF LIFE OUTCOMES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2015PD12-03 IMPACT OF ADHERENCE TO QUALITY MEASURES FOR LOCALIZED PROSTATE CANCER ON HEALTH-RELATED QUALITY OF LIFE OUTCOMES William Sohn, Sharon Phillips, Brock O'neil, Matthew Resnick, Tatsuki Koyama, David Penson, Daniel Barocas, and CEASAR Investigators William SohnWilliam Sohn More articles by this author , Sharon PhillipsSharon Phillips More articles by this author , Brock O'neilBrock O'neil More articles by this author , Matthew ResnickMatthew Resnick More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , David PensonDavid Penson More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , and CEASAR InvestigatorsCEASAR Investigators More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1055AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Quality indicators endorsed by national quality consortia have yet to be validated with clinical outcomes. Our objective was to determine the impact of adherence to quality indicators for localized prostate cancer on health-related quality of life (HRQOL) outcomes. METHODS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a population-based, prospective cohort study that enrolled 3691 men with clinically localized prostate cancer during 2011 and 2012, of which 2781 underwent chart abstraction. Compliance with seven quality indicators endorsed by National Quality Forum (NQF), Physician Consortium for Performance Improvement (PCPI) and Physician Quality Reporting Initiative (PQRI), was assessed. Multivariable regression was used to determine the relationship between the compliance of each indicator with scores obtained from the Expanded Prostate Cancer Index Composite (EPIC) instrument, while controlling for treatment type, patient characteristics, and disease characteristics. RESULTS Overall rates of compliance with these quality measures ranged between 64–88%. Rates of compliance with documentation-related measures were higher than for other processes of care. Three of the seven measures were weakly associated with some of the 6- and/or 12-month EPIC domain scales for sexual function and bowel function (table), while the remaining measures had no significant effect on patient-reported HRQOL. These differences in score are unlikely to be clinically meaningful changes. Other EPIC domains (irritative and incontinence) were not significantly associated with compliance with quality indicators. CONCLUSIONS While three of seven nationally endorsed quality indicators had statistically significant associations with EPIC scores, the magnitude of these relationships were not clinically significant. Compliance with these measures does not seem to influence patient-centered outcomes within 12 months. It is possible that composite measures of quality would have more of an effect on these outcomes. It is also possible that these measures may influence other outcomes, such as indices of value or efficiency. We propose that national quality consortia should indicate the anticipated effect of adherence to quality measures, so that the value of adherence to these measures can be ascertained objectively. Quality Measure Compliance Rate EPIC1 Coefficient2 p-value Avoidance of bone scan in men with low-risk tumors 76.5% No significant associations Use of bone scan in appropriately selected patients (high risk) 73.1% No significant associations ADT for High Risk patients undergoing XRT 75.0% No significant associations Documentation cT stage, biopsy Gleason at new diagnosis 72.2% Sexual 6 month 3.94 0.02 Sexual 12 month 3 0.04 Documentation of DRE, cT stage, biopsy Gleason prior to 1° therapy 64.0% Sexual 6 month 3.14 0.03 Documentation of discussion of treatment options 85.9% No significant associations Documentation of pathologic T and N stage, Gleason score, and margin status on pathology report 87.6% Bowel 6 month 1.8 0.03 (1) EPIC Summary Scores 0 to 100 (2) Adjusting for age, race, education level, income, insurance, marital status, employment status, comorbidities, biopsy gleason, PSA, cT stage, and SEER site © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e256-e257 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Sohn More articles by this author Sharon Phillips More articles by this author Brock O'neil More articles by this author Matthew Resnick More articles by this author Tatsuki Koyama More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author CEASAR Investigators More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...