title: Receipt of best care according to current quality of care measures and outcomes in men with prostate cancer.
abstract: OBJECTIVE
  We evaluated whether patients with prostate cancer who received best care according to a set of 5 nationally endorsed quality measures had decreased treatment related morbidity and improved cancer control.
  
  
  METHODS
  In this retrospective cohort study we included 38,055 men from the SEER (Surveillance, Epidemiology and End Results)-Medicare database treated for localized prostate cancer between 2004 and 2010. We determined whether each patient received best care, defined as care adherent to all applicable measures. We measured associations of best care with the need for interventions, addressing treatment related morbidity, and with the need for secondary cancer therapy using Cox proportional hazards models.
  
  
  RESULTS
  Only 3,412 men (9.0%) received best care. Five years after treatment these men and men who did not receive best care had a similar likelihood of undergoing procedures for urinary morbidity (prostatectomy subset 10.7% vs 12.9%, p = 0.338) and secondary cancer therapy (prostatectomy for high risk prostate cancer subset 40.9% vs 37.3%, p = 0.522). However, they were more likely to be treated with a procedure for sexual morbidity (prostatectomy 17.3% vs 10.8%, p <0.001). Similar trends were observed in men treated with radiotherapy.
  
  
  CONCLUSIONS
  Overall men who received best care did not fare better in regard to treatment related morbidity or cancer control. Collectively our findings suggest that the current process of care measures are not tightly linked to outcomes and further research is needed to identify better measures that are meaningful and important to patients.
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; Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.
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. 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; D017063:Outcome Assessment, Health Care; D011471:Prostatic Neoplasms / Q000628:therapy*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies
keywords: outcome assessment (health care); prostatectomy; prostatic neoplasms; quality of health care; urination disorders
references.citation: J Clin Oncol. 2003 May 15;21(10):1928-36
references.pmid: 12743145
references.citation: Med Care. 2000 Aug;38(8):868-76
references.pmid: 10929998
references.citation: Patient Educ Couns. 2012 Aug;88(2):262-7
references.pmid: 22608696
references.citation: J Natl Cancer Inst. 2011 Jan 19;103(2):117-28
references.pmid: 21228314
references.citation: JAMA. 2006 Mar 8;295(10):1168-70
references.pmid: 16522838
references.citation: CA Cancer J Clin. 2004 Mar-Apr;54(2):78-93
references.pmid: 15061598
references.citation: Eur Urol. 2014 Jan;65(1):162-8
references.pmid: 22790288
references.citation: Cancer. 2012 Sep 15;118(18):4421-6
references.pmid: 22298310
references.citation: Surgery. 2009 Jun;145(6):610-6
references.pmid: 19486760
references.citation: N Engl J Med. 2002 Apr 11;346(15):1138-44
references.pmid: 11948274
references.citation: JAMA. 2009 Oct 14;302(14):1557-64
references.pmid: 19826025
references.citation: J Urol. 2014 Apr;191(4):957-62
references.pmid: 24144685
references.citation: J Natl Cancer Inst Monogr. 2012 May;2012(44):11-9
references.pmid: 22623591
references.citation: JAMA. 1998 Sep 16;280(11):969-74
references.pmid: 9749478
references.citation: J Urol. 2014 Sep;192(3):743-8
references.pmid: 24681332
references.citation: Med Care. 2007 Jun;45(6):489-96
references.pmid: 17515775