title: Health Care Integration and Quality among Men with Prostate Cancer.
abstract: The delivery of high quality prostate cancer care is increasingly important for health systems, physicians and patients. Integrated delivery systems may have the greatest ability to deliver high quality, efficient care. We sought to understand the association between health care integration and quality of prostate cancer care.
  
  
  
  We used SEER-Medicare data to perform a retrospective cohort study of men older than age 65 with prostate cancer diagnosed between 2007 and 2011. We defined integration within a health care market based on the number of discharges from a top 100 integrated delivery system, and compared rates of adherence to well accepted prostate cancer quality measures in markets with no integration vs full integration (greater than 90% of discharges from an integrated system).
  
  
  
  The average man treated in a fully integrated market was more likely to receive pretreatment counseling by a urologist and radiation oncologist (62.6% vs 60.3%, p=0.03), avoid inappropriate imaging (72.2% avoided vs 60.6%, p <0.001), avoid treatment when life expectancy was less than 10 years (23.7% vs 17.3%, p <0.001) and avoid multiple hospitalizations in the last 30 days of life (50.2% vs 43.6%, p=0.001) than when treated in markets with no integration. Additionally, patients treated in fully integrated markets were more likely to have complete adherence to all eligible quality measures (OR 1.38, 95% CI 1.27-1.50).
  
  
  
  Integrated systems are associated with improved adherence to several prostate cancer quality measures. Expansion of the integrated health care model may facilitate greater delivery of high quality prostate cancer care.
authors.affiliation: Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Herrel
authors.affiliation: Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.affiliation: Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Yan
authors.affiliation: Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: White River Junction VA Medical Center, White River Junction, Vermont, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.affiliation: Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.affiliation: Kidney Epidemiology Cost Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
authors.affiliation: Dow Division for Urological Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: bhollen@umich.edu.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D019033:Delivery of Health Care, Integrated; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D006278:Medicare; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D015996:Survival Rate; D014481:United States
keywords: Medicare; accountable care organizations; delivery of health care; health care; integrated; prostatic neoplasms; quality indicators