title: Adherence to performance measures and outcomes among men treated for prostate cancer.
abstract: OBJECTIVE
  We assessed the relationship between health care system performance on nationally endorsed prostate cancer quality of care measures and prostate cancer treatment outcomes.
  
  
  METHODS
  This retrospective cohort study included 48,050 men from SEER-Medicare linked data diagnosed with localized prostate cancer between 2004 and 2009, and followed through 2010. Based on a composite quality measure we categorized the health care systems in which these men were treated into 1-star (bottom 20%), 2-star (middle 60%) and 3-star (top 20%) systems. We then examined the association of health care system level quality of care with outcomes using multivariable logistic and Cox regression.
  
  
  RESULTS
  Patients who underwent prostatectomy in 3-star vs 1-star health care systems were at lower risk for perioperative complications (OR 0.80, 95% CI 0.64-1.00). However, they were more likely to undergo a procedure addressing treatment related morbidity, eg for sexual morbidity (11.3% vs 7.8%, p = 0.043). In patients who received radiotherapy star ranking was not associated with treatment related morbidity. In all patients star ranking was not significantly associated with all-cause mortality (HR 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20).
  
  
  CONCLUSIONS
  We found no consistent association between health care system quality and outcomes, which questions how meaningful these measures ultimately are for patients. Thus, future studies should focus on developing more discriminative quality measures.
authors.affiliation: Division of Health Services Research, Department of Urology, 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, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, Health Services Research and Development Service, 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, Department of Urology, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.affiliation: Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: Division of Health Services Research, Department of Urology, 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; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011471:Prostatic Neoplasms / Q000628:therapy*; D011787:Quality of Health Care / Q000145:classification / Q000592:standards; D012189:Retrospective Studies
keywords: Medicare; SEER program; prostate; prostatic neoplasms; quality of health care