title: Regional variation in quality of prostate cancer care.
abstract: OBJECTIVE
  Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated regional variation in adherence to these quality measures to identify targets for future quality improvement.
  
  
  METHODS
  For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted regional adherence to the endorsed quality measures.
  
  
  RESULTS
  Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition, there was considerable regional variation in adherence to several measures, including pretreatment counseling by a urologist and radiation oncologist (range 9% to 89%, p <0.001), avoiding overuse of bone scans in low risk cancer (range 16% to 96%, p <0.001), treatment by a high volume provider (range 1% to 90%, p <0.001) and followup with radiation oncologists (range 14% to 86%, p <0.001).
  
  
  CONCLUSIONS
  We found low adherence rates for most established prostate cancer quality of care measures. Within most measures regional variation in adherence was pronounced. Measures with low adherence and a large amount of regional variation may be important low hanging targets for quality improvement.
authors.affiliation: Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.affiliation: Division of Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.affiliation: Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan; HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.affiliation: Division of Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
authors.affiliation: Division of Health Services Research, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: bhollen@med.umich.edu.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000628:therapy*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: health services research; prostatic neoplasms; quality improvement; quality of health care; small-area analysis