SUO 2017: Quality Improvement Initiative for Patients with Muscle-Invasive Bladder Cancer

Washington, DC ( Dr. Milowsky and colleagues presented their research on a quality improvement (QI) initiative for patients with muscle-invasive bladder cancer (MIBC). Thought leaders in the field have called for QI initiatives in response to suboptimal care for patients with MIBC. As such, the objective of this study was to evaluate the impact of a QI program at two MIBC centres regarding quality-focused interventions on assessment, treatment, and patient-centered care processes.

This study was conducted at a large public health system and a private regional oncology center. Participants were teams of medical and urologic oncologists, urologists, nurses, radiologists, and pathologists (n = 47 across both systems). At baseline, the authors reviewed 200 consecutive charts of MIBC patients (100 charts in each system) for documentation of guideline-directed practices, including staging and neoadjuvant chemotherapy, and provision of patient-centered care processes central to new national healthcare delivery and payment programs.

Following the baseline assessment, the teams participated in a series of QI interventions, including two onsite and two online accredited educational activities. In the onsite activities, the teams received chart audit feedback and developed written action plans for improvement of suboptimal measures. Six months after the QI interventions, 200 charts were reviewed according to the same methods for the baseline review. Chi-square tests were conducted to analyze pre- and post-intervention differences in rates of chart documentation. Rates of chart documentation were significantly higher in the post-intervention versus baseline for: (i) use of neoadjuvant chemotherapy (+12%, p=0.004), (ii) assessment of quality of life (+11%, p=0.005) and depression (+12%, p=0.001), (iii) provision of patient counseling and education about bladder cancer and its treatment (+36%, p<0.001), (iv) and shared decision-making (+13%, p=0.003). High rates of bladder cancer staging were documented in the baseline (84%) and post-intervention (86%) samples. The teams’ action plans included initiating multidisciplinary MIBC tumor board meetings and updating methods for assessing patient-centered needs.

The authors concluded that QI educational interventions are associated with increased team-based adherence to guideline-directed treatment and patient-centered care processes in MIBC. Given the treatment decisions, body dysmorphic procedures, and high rates of depression and psychological impact for patients with MIBC, these initiatives should be funded and strongly encouraged.

Presented by: Matthew I. Milowsky, Division of Hematology and Oncology, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
Co-Authors: Joshua Meeks, Thomas Lad, Sarah Psutka, David Chu, Maury Jayson, Kristina Fajardo, James Mateka, Jeffrey D. Carter, Tamar Sapir, Daniel P. Petrylak

Written By: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC
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