title: Improvement in clinical TNM staging documentation within a prostate cancer quality improvement collaborative.
abstract: OBJECTIVE
  To assess the effectiveness of a feedback and educational intervention to increase documentation of clinical tumor-node-metastasis (TNM) stage among urologists in a statewide quality improvement collaborative.
  
  
  METHODS
  The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of urology practices that aims to improve the quality and cost-efficiency of prostate cancer care. In pilot data collection activities, trained abstractors recorded medical record documentation of clinical TNM stage by participating urologists. We compared levels of TNM stage documentation in 12 MUSIC practices at baseline and after performance feedback and a collaborative-wide educational intervention. We examined patient and practice characteristics associated with documentation of TNM stage.
  
  
  RESULTS
  We accrued 491 and 581 men with newly diagnosed prostate cancer during the baseline and postfeedback phases of data collection, respectively. At baseline, 58% of patients had clinical TNM staging in the medical record, ranging from 19% to 96% across 12 practices (P <.05). After the intervention, documentation improved to 79% of patients overall, with 7 individual practices achieving significant improvements (all P <.05). The greatest improvements in documentation occurred among patients treated in smaller practices (ie, 1-4 urologists).
  
  
  CONCLUSIONS
  After collaborative review of staging criteria and feedback of baseline performance, urologists in MUSIC practices dramatically improved documentation of clinical TNM stage. This finding underscores the behavioral change possible with the collaborative quality improvement model and ensures the necessary risk stratification data for our ongoing efforts to improve care.
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Urologic Consultants, Grand Rapids, MI.
authors.forename: Brooke
authors.initials: B
authors.lastname: Boer
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Urologic Consultants, Grand Rapids, MI.
authors.forename: Jon
authors.initials: J
authors.lastname: Curry
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Susan
authors.initials: S
authors.lastname: Linsell
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI. Electronic address: dcmiller@med.umich.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
mesh_terms: D003362:Cost-Benefit Analysis; D003625:Data Collection; D006801:Humans; D008297:Male; D008824:Michigan; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods* / Q000592:standards*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000592:standards; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D058996:Quality Improvement; D011787:Quality of Health Care; D016896:Treatment Outcome; D014572:Urology / Q000592:standards