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Impact of Adherence to Quality Measures for Localized Prostate Cancer on Patient-reported Health-related Quality of Life Outcomes, Patient Satisfaction, and Treatment-related Complications

Sohn, William MD; Resnick, Matthew J. MD, MPH; Greenfield, Sheldon MD; Kaplan, Sherrie H. PhD, MS, MPH; Phillips, Sharon MSPH; Koyama, Tatsuki PhD; Goodman, Michael MD, MPH; Hamilton, Ann S. PhD, MA; Hashibe, Mia PhD, MPH; Hoffman, Karen E. MD, MHSc, MPH; Paddock, Lisa E. PhD, MPH; Stroup, Antoinette M. PhD; Wu, Xiao-Cheng MD, MPH; Penson, David F. MD, MPH; Barocas, Daniel A. MD, MPH

doi: 10.1097/MLR.0000000000000562
Patient-centered Care

Background and Objective: Quality measures used in pay-for-performance systems are intended to address specific quality goals, such as safety, efficiency, effectiveness, timeliness, equity, and patient-centeredness. Given the small number of narrowly focused measures in prostate cancer care, we sought to determine whether adherence to any of the available payer-driven quality measures influences patient-centered outcomes, including health-related quality of life (HRQOL), patient satisfaction, and treatment-related complications.

Methods: The Comparative Effectiveness Analysis of Surgery and Radiation study is a population-based, prospective cohort study that enrolled 3708 men with clinically localized prostate cancer during 2011 and 2012, of whom 2601 completed the 1-year survey and underwent complete chart abstraction. Compliance with 6 quality indicators endorsed by national consortia was assessed. Multivariable regression was used to determine the relationship between indicator compliance and Expanded Prostate Cancer Index Composite (EPIC-26) instrument summary scores, satisfaction scale scores (service satisfaction scale for cancer care), and treatment-related complications.

Results: Overall rates of compliance with these quality measures ranged between 64% and 88%. Three of the 6 measures were weakly associated with 1-year sexual function and bowel function scores (β=−4.6, 1.69, and 2.93, respectively; P≤0.05), whereas the remaining measures had no significant relationship with patient-reported HRQOL outcomes. Satisfaction scores and treatment-related complications were not associated with quality measure compliance.

Conclusions: Compliance with available nationally endorsed quality indicators, which were designed to incentivize effective and efficient care, was not associated with clinically important changes in patient-centered outcomes (HRQOL, satisfaction, or complications) within 1-year.

*Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN

Center for Health Policy Research

Department of Medicine

§Health Policy Research Institute, University of California, Irvine, CA

Department of Biostatistics, Vanderbilt University, Nashville, TN

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA

#Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA

**Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT

††Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

‡‡New Jersey Department of Health, Cancer Epidemiology, Trenton

§§Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ

∥∥School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA

¶¶Tennessee Valley Veterans Administration Healthcare System, Nashville, TN

Supported by the Agency for Healthcare Research and Quality (1R01HS019356, 1R01HS022640). The study centers were supported by NIH/NCI contracts (N01-PC-67007, N01-PC-67009, N01-PC-67010, N01-PC-67006, N01-PC-67005, and N01-PC-67000). The data management were facilitated by the use of Vanderbilt University’s Research Electronic Data Capture (REDCap) system, which is supported by the Vanderbilt Institute for Clinical and Translational Research grant (UL1TR000011 from NCATS/NIH). The Louisiana Tumor Registry receives support from the SEER Program of the National Cancer Institute (NCI) under contract HHSN261201300016I, the National Program of Cancer Registries, Centers for Disease Control and Prevention under cooperative agreement 5U58DP003915-03, State of Louisiana and the University Medical Center Management Corporation dba Interim LSU Hospital funding PH-15-141-005. The New Jersey State Cancer Registry receives support from the SEER Program of the NCI under contract no. HHSN 261201300021I, the National Program of Cancer Registries, Centers for Disease Control and Prevention under cooperative agreement 5U58DP003931-02, the State of New Jersey, and the Rutgers Cancer Institute of New Jersey. The Utah Cancer Registry is funded by contract no. HHSN2612013000171 from the NCI SEER Program with additional support from the Utah State Department of Health and the University of Utah. The Los Angeles County cancer incidence data used in this study were supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the NCI SEER Program under contract HHSN261201000035C awarded to the University of Southern California; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. CaPSURE is supported in part by an independent, unrestricted educational grant from Abbott and by the US Department of Defense Prostate Cancer Research Program (W81XWH-13-2-0074 and W81XWH-11-1-0489). CaPSURE/CEASAR has been funded by the Agency for Research and Quality (AHRQ) and the Patient-centered Outcomes Research Institute (PCORI).

The authors declare no conflict of interest.

Reprints: William Sohn, MD, A1302 Medical Center North, Nashville, TN 37232. E-mail:

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