Developing an Instrument to Measure Socioeconomic Disparities in Quality of Care for Men with Early Stage Prostate Cancer

2010 ◽  
Author(s):  
Theresa Koppie
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Early Stage ◽  
Socioeconomic Disparities

Geographic and Socioeconomic Variation in the Treatment of Prostate Cancer

2005 ◽  
Vol 23 (31) ◽  
pp. 7881-7888 ◽  
Author(s):  
Tracey L. Krupski ◽  
Lorna Kwan ◽  
Abdelmonem A. Afifi ◽  
Mark S. Litwin
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Low Income ◽  
Watchful Waiting ◽  
Early Stage ◽  
Specific Antigen ◽  
Primary Treatment ◽  
Sufficient Information ◽  
Socioeconomic Variation

Purpose Within a framework of quality assessment, primary treatment choice constitutes an indicator of quality of care. This study examines geographic and socioeconomic variation in the primary treatment of men with prostate cancer during the era of prostate-specific antigen testing. Methods Using the National Cancer Institute's Surveillance, Epidemiology, and End Results public use data files, we identified men with localized/regional prostate cancer who underwent surgery, radiation therapy, or watchful waiting. We used the year 2000 US Census information to ascribe education and income levels to these men based on their county of residence and ethnicity. Results Among the 96,769 men with localized/regional prostate cancer (during 1995 to 1999) who had sufficient information for analysis, we observed significant geographic variation nationwide in surgical, radiation, and watchful waiting treatment rates (P <.0015). Patterns noted 10 years ago, such as higher surgical rates in western regions, persisted. Ethnicity, income, and grade were all independently associated with primary treatment, or lack thereof. Blacks and low-income patients had the lowest rates of surgery and radiation. Grade was the best predictor of aggressive treatment. Conclusion Nonclinical factors, such as ethnicity and income, were associated with the use of watchful waiting rather than surgery or radiation in men with early-stage prostate cancer. These findings have implications for quality of care.

186: Quality-of-care Indicators for Early-Stage Prostate Cancer

2005 ◽  
Vol 173 (4S) ◽  
pp. 51-51 ◽  
Author(s):  
Benjamin A. Spencer ◽  
Elizabeth McGlynn ◽  
Michael Steinberg ◽  
John Adams ◽  
Claude M. Setodji ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Early Stage

Quality-of-Care Indicators for Early-Stage Prostate Cancer

2003 ◽  
Vol 21 (10) ◽  
pp. 1928-1936 ◽  
Author(s):  
Benjamin A. Spencer ◽  
Michael Steinberg ◽  
Jennifer Malin ◽  
John Adams ◽  
Mark S. Litwin
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Early Stage ◽  
Disease Free Survival ◽  
Assessment Tools ◽  
Medical Decision ◽  
Consensus Method ◽  
Structured Interviews ◽  
Care Assessment

Purpose: Decisions regarding treatment for early-stage prostate cancer are frustrated not only by inadequate evidence favoring one treatment modality but also by the absence of data comparing quality among providers. In fact, the choice of provider may be as important as the choice of treatment. We undertook this study to develop an infrastructure to evaluate variations in quality of care for men with early-stage prostate cancer. Methods: We enlisted several sources to develop a list of proposed quality-of-care indicators and covariates. After an extensive structured literature review and a series of focus groups with patients and their spouses, we conducted structured interviews with national academic leaders in prostate cancer treatment. We then convened an expert panel using the RAND consensus method to discuss and rate the validity and feasibility of the proposed quality indicators and covariates. Results: The panel endorsed 49 quality-of-care indicators and 14 covariates, which make up our final list of candidate measures. Several domains of quality are represented in the selected indicators, including patient volume, pretreatment referrals, preoperative testing, interpretation of pathology specimens, and 10-year disease-free survival. Covariates include measures of case-mix, such as patient age and comorbidity. Conclusion: This study establishes a foundation on which to build quality-of-care assessment tools to evaluate the treatment of early-stage prostate cancer. The next step is to field-test the indicators for feasibility, reliability, validity, and clinical utility in a population-based sample. This work will begin to inform medical decision-making for patients and their physicians.

Variations in Quality of Care for Men With Early-Stage Prostate Cancer

2008 ◽  
Vol 26 (22) ◽  
pp. 3735-3742 ◽  
Author(s):  
Benjamin A. Spencer ◽  
David C. Miller ◽  
Mark S. Litwin ◽  
Jamie D. Ritchey ◽  
Andrew K. Stewart ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Cancer Care ◽  
Early Stage ◽  
External Beam Radiation ◽  
Hospital Type ◽  
Beam Radiation ◽  
Cancer Centers

Purpose The commencement of quality-improvement initiatives such as Pay for Performance and the Physician Consortium for Performance Improvement has underscored calls to evaluate the quality of cancer care on a patient level for nationally representative samples. Methods We sampled early-stage prostate cancer cases diagnosed in 2000 through 2001 from the American College of Surgeons National Cancer Data Base and explicitly reviewed medical records from 2,775 men (weighted total = 55,160 cases) treated with radical prostatectomy or external-beam radiation therapy. We determined compliance with 29 quality-of-care disease-specific structure and process indicators developed by RAND, stratified by race, geographic region, and hospital type. Results Overall compliance exceeded 70% for structural and pretherapy disease assessment indicators but was lower for documentation of pretreatment functioning (46.4% to 78.4%), surgical pathology (37.1% to 86.3%), radiation technique (62.6% to 88.3%), and follow-up (55%). Geographic variations were observed as higher compliance in the South Atlantic division than the New England division for having at least one board-certified urologist (odds ratio [OR], 9.2; 95% CI, 1.9 to 45.0), at least one board-certified radiation oncologist (OR, 3.3; 95% CI, 1.2 to 9.0), use of Gleason grading (OR, 4.1; 95% CI, 1.2 to 13.8), and administering total radiation dose ≥ 70 Gy (OR, 3.1; 95% CI, 1.6 to 6.1). Teaching/research hospitals and Comprehensive Cancer Centers had higher compliance than Community Cancer Centers, whereas racial differences were not observed for any indicator. Conclusion The significant and unwarranted variations observed for these quality indicators by census division and hospital type illustrate the inconsistencies in prostate cancer care and represent potential targets for quality improvement. The lack of racial disparities suggests equity in care once a patient initiates treatment.

Quality of Care in the Treatment of Localized Intermediate and High Risk Prostate Cancer at Minority Serving Hospitals

2019 ◽  
Vol 201 (4) ◽  
pp. 735-741 ◽  
Author(s):  
Marieke J. Krimphove ◽  
Sean A. Fletcher ◽  
Alexander P. Cole ◽  
Sebastian Berg ◽  
Maxine Sun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
High Risk ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer
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