Use of quality indicators to evaluate the care of patients with localized prostate carcinoma.
BACKGROUND
The goal of quality assurance in health care is to preserve and improve patient care. Recently, RAND developed a set of evidence-based candidate indicators for evaluating the quality of care for patients with localized prostate carcinoma; however, the feasibility and sensitivity of these indicators have not been tested in a clinical setting. The objectives of this study were to evaluate the feasibility of measuring these quality indicators and to determine their sensitivity to change in practice patterns over time.


METHODS
One hundred sixty-eight men who presented in either 1995 or in 2000 and were treated for localized prostate carcinoma were selected randomly from the University of Michigan tumor registry. A combination of electronic data base review and explicit chart review was used to assess the feasibility of measuring compliance for each indicator. For each indicator in which assessment was feasible, compliance with the RAND indicators was determined for patients in both years. Multivariate regression analysis was used to adjust for potential confounding effects of disease stage, tumor grade, prostate specific antigen (PSA) level, patient age, and therapy.


RESULTS
Based on review of available clinical data, measurement of compliance was feasible for 19 of 22 RAND candidate quality indicators (86%). For five indicators, significant differences in documentation (compliance) were detected between 1995 and 2000 (P < 0.05). Treatment received and higher PSA levels were associated independently with documentation of compliance for several indicators (P < 0.05).


CONCLUSIONS
Measurement of the majority of the RAND quality indicators for the treatment of patients with localized prostate carcinoma was feasible, and improvements in several indicators were observed between 1995 and 2000. Demonstration of such variation, even within a single institution, suggests that the indicators are sufficiently sensitive to detect differences in practice patterns.
Miller
David C
DC
Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA.
Litwin
Mark S
MS
Sanda
Martin G
MG
Montie
James E
JE
Dunn
Rodney L
RL
Resh
Jennifer
J
Sandler
Howard
H
Wei
John T
JT
D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D003430:Cross-Sectional Studies; D004282:Documentation; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen