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

Benjamin A. Spencer, Michael Steinberg, Jennifer Malin, John Adams, Mark S. Litwin

From the RAND Health Science Program, Santa Monica, CA; the Veteran’s Administration/Robert Wood Johnson Clinical Scholars Program, Los Angeles, CA; and the Departments of Medicine, Urology, and Health Services, University of California, Los Angeles, CA.

Address reprint requests to Mark S. Litwin, MD, MPH, University of California, Los Angeles, Department of Urology, Box 951738, Los Angeles, CA 90095-1738; email: mlitwin{at}mednet.ucla.edu.

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.

The views expressed are those of the authors and do not necessarily reflect those of the Robert Wood Johnson Foundation.

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