Quality of prostate carcinoma care in a statewide public assistance program.
BACKGROUND
The authors evaluated the feasibility of measuring quality of care in a statewide public assistance program for men with prostate carcinoma.


METHODS
The sample consisted of 84 men who were followed for > or = 6 months after receiving primary treatment for early-stage prostate carcinoma (55 received radical prostatectomy and 29 received radiotherapy) through a free public program for low-income, uninsured men. Quality was assessed by chart review with 16 indicators previously developed and validated at the RAND Corporation, as well as by telephone and mail surveys that included the University of California at Los Angeles Prostate Cancer Index short form.


RESULTS
Quality of care measurement was feasible for 13 (81%) indicators from electronic chart abstraction, administrative documents, and patient questionnaires. Communication between specialist and primary physician was better for men treated with radiotherapy than with surgery (84% vs. 45%, P = 0.004). Subjects treated in private institutions were more likely than those treated in public institutions to have > or = 2 follow-up visits with the treating physician or institution within 1 year of treatment (93% vs. 63%, P = 0.003) and to have documentation of communication with the primary care physician (90% vs. 40%, P << 0.0001). Disease-specific, health-related quality of life 6 months after treatment did not appear to differ between public and private facilities.


CONCLUSIONS
The authors found the application of quality of care indicators to be feasible in a statewide public assistance program, but with some differences between public and private providers. These quality of care indicators identified target areas for improvement.
Krupski
Tracey L
TL
Department of Urology and Health Services, David Geffen School of Medicine, School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California 90095-1738, USA. tkrupski@mednet.ucla.edu
Bergman
Jonathan
J
Kwan
Lorna
L
Litwin
Mark S
MS
D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy*; D011632:Public Assistance; D011785:Quality Assurance, Health Care