AUA 2017: Measuring to Improve: Patient Reported Outcomes during the First Year after Prostatectomy in a Statewide Collaborative

Boston, MA (UroToday.com) The assessment of urinary continence and erectile function following radical prostatectomy (RP) has recently experienced a paradigm shift from objective measurement to patient-reported outcomes (PRO). Dr. Gregory Auffenberg presents Michigan Urological Surgery Improvement Collaborative (MUSIC) as one of the first programs for post-RP outcome assessment programs relying on PRO.

Initiated in 2014, MUSIC PRO collects both urinary function (UF) and erectile function (EF) outcomes via electronic, validated questionnaire data at 3, 6, 12, and 24 months post-RP. As a statewide collaboration funded by Blue Cross / Blue Shield of Michigan, MUSIC PRO includes men treated in 23 diverse academic and community practices. While such data is often corroborated by low response rates and the “telescope effect”, MUSIC PRO boasts a 65-80% response rate through the first year, with 1,593 and 1,447 men completing baseline surveys (83% baseline response).

All patients treated by surgeons with low volume (<10 patients per year) were excluded from analysis, leaving 21 MUSIC surgeons in analysis. UF was defined as a score >16 (range 0-21), with 77.6% reporting UF at baseline; post-RP, 38.9% recover similar UF at 3 months and 65.3% by one year. EF, by a score >21 (range 0-30), with 58.6% reporting good function at baseline, decreasing to 10.6% at 3 months and 21.8% after one year. Across the 21 MUSIC surgeons, the proportion of patients returning to good UF by 3 months ranged significantly from 0-64% (p<0.001).

The top five surgeons reporting good UF outcomes appear to have superior outcomes independent of patient characteristics. While superior (average) UF among patients were observed, inter-surgeon outcome inconsistencies are concerning. Further, maturation of data allowing longitudinal analysis of EF is a significant challenge. While MUSIC PRO offers a unique opportunity in addressing PRO response rate via systematic approach, patient outcomes improvement will be the ultimate test of the MUSIC’s efficacy.

Presented by: Gregory Auffenberg, MD, University of Michigan

Authors: Gregory Auffenberg*, Rodney Dunn, Tae Kim, Ann Arbor, MI, James Peabody, Mani Menon, Detroit, MI, David Miller, for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI

Affiliation: Department of Urology, Tan Tock Seng Hospital, Singapore

Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of UroToday.com.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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