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).
CONCLUSION: Our findings suggest that new technology is not clearly associated with higher quality of care. To improve quality, more specific efforts will be needed.
Written by:
Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Zhang Y, Hollenbeck BK. Are you the author?
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; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; 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.
Reference: Urology. 2014 Nov;84(5):1066-72.
doi: 10.1016/j.urology.2014.06.067
PubMed Abstract
PMID: 25443905