title: Technology diffusion and prostate cancer quality of care.
abstract: OBJECTIVE
  To evaluate the association of technological capacity with prostate cancer quality of care. Technological capacity was conceptualized as a market's ability to provide prostate cancer treatment with new technology, including robotic prostatectomy and intensity-modulated radiotherapy (IMRT).
  
  
  METHODS
  In this retrospective cohort study, we used data from the Surveillance, Epidemiology, and End Results-Medicare linked database from 2004 to 2009 to identify men with newly diagnosed prostate cancer (n = 46,274). We measured technological capacity as the number of providers performing robotic prostatectomy or IMRT per population in a health care market. We used multilevel logistic regression analysis to assess the association of technological capacity with receiving quality care according to a set of nationally endorsed quality measures, while adjusting for patient and market characteristics.
  
  
  RESULTS
  Overall, our findings were mixed with only subtle differences in quality of care comparing high-tech with low-tech markets. High robotic prostatectomy capacity was associated with better adherence to some quality measures, such as avoiding unnecessary bone scans (79.8% vs 73.0%; P = .003) and having follow-up with urologists (67.7% vs 62.6%; P = .023). However, for most measures, neither high robotic prostatectomy nor high-IMRT capacity was associated with significant increases in adherence rates. In fact, for 1 measure (treatment by a high-volume provider), high-IMRT capacity was associated with lower performance (23.4% vs 28.5%; P <.001).
  
  
  CONCLUSIONS
  Our findings suggest that new technology is not clearly associated with higher quality of care. To improve quality, more specific efforts will be needed.
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI.
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, MI.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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, MI; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
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, MI.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: bhollen@med.umich.edu.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D004059:Diffusion of Innovation; D006801:Humans; D016015:Logistic Models; D008297:Male; D011467:Prostate / Q000601:surgery; D011471:Prostatic Neoplasms / Q000601:surgery* / Q000628:therapy*; D011787:Quality of Health Care; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States