title: The quality of surgical pathology care for men undergoing radical prostatectomy in the U.S.
abstract: BACKGROUND
  The authors assessed adherence with the College of American Pathologists (CAP) radical prostatectomy (RP) practice protocol in a national sample of men who underwent RP for early-stage prostate cancer.
  
  
  METHODS
  Using the National Cancer Data Base, the authors identified a nationally representative sample of 1240 men (unweighted) who underwent RP. For each patient, local cancer registrars performed an explicit medical record review to assess patient-level compliance with surgical pathology report documentation of 7 morphologic criteria (ie, quality indicators). Applying the CAP prognostic factor classification framework, composite measures and all-or-none measures of quality indicator compliance were calculated for the following analytic categories: 1) a strict subset of CAP category I prognostic factors (3 indicators), 2) a broad subset of CAP category I factors (6 indicators), and 3) the full set of 7 indicators.
  
  
  RESULTS
  Among a weighted sample of 24,420 patients who underwent RP, compliance with documentation of the CAP category I factors varied from 54% (95% confidence interval [95% CI], 50-58%) for pathologic tumor, lymph node, metastases classification (according to the American Joint Committee on Cancer staging system) to 97% (95% CI, 96-99%) for Gleason score. In composite, RP pathology reports contained 83% (95% CI, 81-84%), 85% (95% CI, 84-87%), and 79% (95% CI, 78-80%) of the recommended data elements measured by the strict CAP category I subset, the broad CAP category I subset, and the full set of 7 indicators, respectively. In contrast to the generally higher composite scores, only 52% (95% CI, 48-56%) and 41% (95% CI, 37-45%) of men who underwent RP had complete documentation in their pathology reports for the strict and broad CAP category I subsets, respectively.
  
  
  CONCLUSIONS
  RP surgical pathology reports contained most of the recommended data elements; however, the frequent absence of pathologic stage provides an opportunity for quality improvement.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095-1738, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Spencer
authors.forename: Rajal B
authors.initials: RB
authors.lastname: Shah
authors.forename: Jamie
authors.initials: J
authors.lastname: Ritchey
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: E Greer
authors.initials: EG
authors.lastname: Gay
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010340:Pathology, Surgical / Q000592:standards; D010818:Practice Patterns, Physicians'; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000592:standards* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D019984:Quality Indicators, Health Care; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen