Healthcare integration and quality among men with prostate cancer

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 healthcare integration and quality of prostate cancer care.

We used SEER-Medicare data to perform a retrospective cohort study of men > 65 years old with prostate cancer diagnosed between 2007 and 2011. We defined integration within a healthcare 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 versus full integration (>90% of discharges from an integrated system).

The average man treated in a fully integrated market was more likely to receive pre-treatment 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 healthcare model may facilitate greater delivery of high quality prostate cancer care.

The Journal of urology. 2016 Jul 13 [Epub ahead of print]

Lindsey A Herrel, Samuel R Kaufman, Phyllis Yan, David C Miller, Florian R Schroeck, Ted A Skolarus, Vahakn B Shahinian, Brent K Hollenbeck

Dow Division for Urological Health Services Research, Department of Urology., Dow Division for Urological Health Services Research, Department of Urology., Dow Division for Urological Health Services Research, Department of Urology., Dow Division for Urological Health Services Research, Department of Urology., White River Junction VA Medical Center, White River Junction, VT; 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, NH., Dow Division for Urological Health Services Research, Department of Urology; VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System., Kidney Epidemiology Cost Center, University of Michigan, Ann Arbor., Dow Division for Urological Health Services Research, Department of Urology. Electronic address: .

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