Urologist practice structure and quality of prostate cancer care.
Urologist practice structure and quality of prostate cancer care.
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DOI：
10.1097/upj.0000000000000123
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发表时间：
2020-09
期刊：
影响因子：
0.8
通讯作者：
Herrel LA
中科院分区：
文献类型：
--
作者：
Modi PK;Yan P;Hollenbeck BK;Kaufman SR;Borza T;Skolarus TA;Schroeck FR;Ryan AM;Shahinian VB;Herrel LA
研究可能影响前列腺癌护理质量的泌尿科医生实践结构的三个方面：实践规模，强度调节放射治疗（IMRT）设备的所有权，参与多专科小组（MSG）。鉴于前列腺癌的普遍性和对过度诊断和过度治疗的担忧，以提高质量为重点的保健改革对前列腺癌尤为重要。使用来自监测、流行病学和最终结果(SEER)-医疗保险相关注册表的数据，我们根据每个治疗泌尿科医生的执业规模、类型（单一专科vs. MSG）和IMRT的所有权来检查前列腺癌治疗的质量。混合模型用于调整患者差异。在研究期间，我们确定了22412名新诊断的前列腺癌患者，接受了2199名泌尿科医生的治疗。根据IMRT的实践规模、类型和所有权，我们观察到大多数质量度量的最小差异。与单一专科组相比，msg组对所有合格质量指标的依从性更好（20.0%的依从性对18.2%,p=0.01），而IMRT所有权没有显著差异（所有者17.1%的依从性对非所有者18.9%,p=0.09）。IMRT在实践规模、类型和所有权之间的质量差异不大，无论实践结构如何，都有很大的改进空间。
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.