To examine three aspects of urologist practice structure that may affect quality of prostate cancer care: practice size, ownership of an intensity modulated radiation therapy (IMRT) device, participation within a multi-specialty group (MSG). Health care reforms focused on improving quality are particularly relevant for prostate cancer given its prevalence and concerns for overdiagnosis and overtreatment.
Using data from the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked registry, we examined quality of prostate cancer treatment according to each treating urologist's practice size, type (single-specialty vs. MSG) and ownership of IMRT. Mixed models were used to adjust for patient differences.
We identified 22,412 men with newly diagnosed prostate cancer treated by 2,199 urologists during the study. We observed minimal differences for most quality metrics according to practice size, type, and ownership of IMRT. Adherence to all eligible quality metrics was better among MSGs compared to single specialty groups (20.0% adherence versus 18.2%, p=0.01) whereas there was no significant difference by ownership of IMRT (17.1% adherence in owners versus 18.9% non-owners, p=0.09).
Differences in quality across practice size, type and ownership of IMRT were modest, with substantial room for improvement regardless of practice structure.
Urology practice. 2020 Sep 01 [Epub]
Parth K Modi, Phyllis Yan, Brent K Hollenbeck, Samuel R Kaufman, Tudor Borza, Ted A Skolarus, Florian R Schroeck, Andrew M Ryan, Vahakn B Shahinian, Lindsey A Herrel
Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI., VA Outcomes Group, White River Junction VA Medical Center, VT, and The Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH., Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI.