Can National Survey Data Be Used to Benchmark Quality Indicators for Prostate Cancer?

Article Outline

• Purpose/Objective(s)
• Materials/Methods
• Results
• Conclusions
• Copyright

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Purpose/Objective(s) 

To assess a national patterns of care survey database as an evidence base for measuring quality indicators (QI) in radiation oncology.

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Materials/Methods 

QI for prostate cancer workup and treatment were developed based on widely accepted research findings and guidelines, such as those of the National Comprehensive Cancer Network (NCCN). Data in the Patterns of Care Study (PCS) database for patients treated in 1999 were analyzed to benchmark QI. The national survey used a two-stage stratified sample of radiation oncology practices and their patients that allowed calculation of national averages of defined measures. Chart reviews of medical and radiation therapy records of patients diagnosed with adenocarcinoma of the prostate with no distant metastases or histologically proven positive paraaortic nodes who started radiation treatment during 1999 provided the data. Cases had no prior or concurrent malignancies and no previous hormone, chemotherapy, or radiation therapy as primary treatment. Following the NCCN guidelines cases were assigned to appropriate groups to measure compliance with QI.

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Results 

Compliance results for QI derived from NCCN guidelines for workup are: digital rectal exam (DRE) done (90%), PSA done (99%), Gleason score done (99%), bone scan performed in recommended patient group (83%), CT or MRI done in recommended patient group (58%). CT or MRI done in recommended patient group varied with method of payment, for private insurance (84%), for Medicare/VA/Champus (49%), for Medicaid/unknown/self pay (20%). QI for initial therapy for patients treated with radiotherapy showed beam energies >10MV used (73%); doses ≥72 Gy used in favorable risk (43%), intermediate risk (38%), and unfavorable risk (60%) patients; androgen deprivation therapy used in unfavorable risk patients (79%); implant as monotherapy in favorable risk (79%).

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Conclusions 

Benchmarking utilization provides a foundation for assessing QI, and this database is a potentially rich source that can be used to validate these measures. In addition to providing evidence on the usefulness of specific proposed QI and identifying areas of practice needing improvement, it provides data on potential future evidence-based QI. As policy makers implement pay for performance (P4P) programs, finding data sources to benchmark QI is important. The required level of detail exceeds most current administrative data, while clinical trials provide data only for a limited set of specific and usually experimental treatments. Well designed surveys can provide a data source with sufficient detail for a broad range of QI, especially if surveys are planned to meet QI needs. They can also help define additional data requirements to allow use of administrative data to implement P4P programs.

Funded by Pennsylvania Department of Health, Tobacco Settlement Act 77–2001, Commonwealth Universal Research Enhancement for Fiscal Year 2005, and NCI grant CA 065435.