420 DOES ADHERENCE TO CANDIDATE QUALITY MEASURES FOR MUSCLE INVASIVE BLADDER CANCER VARY BY HOSPITAL TYPE? (2013)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost effectiveness (III)1 Apr 2013420 DOES ADHERENCE TO CANDIDATE QUALITY MEASURES FOR MUSCLE INVASIVE BLADDER CANCER VARY BY HOSPITAL TYPE? Anthony Corcoran, Elizabeth Handorf, Daniel Canter, Justin Beckelman, Simon Kim, Serge Ginzburg, Alexander Kutikov, Robert Uzzo, and Marc Smaldone Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Elizabeth HandorfElizabeth Handorf Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Atlanta, GA More articles by this author , Justin BeckelmanJustin Beckelman Philadelphia, PA More articles by this author , Simon KimSimon Kim Rochester, MN More articles by this author , Serge GinzburgSerge Ginzburg Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author , and Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1810AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Proposed quality of care measures for treatment of muscle invasive bladder cancer include timely surgery (<3 months from diagnosis), receipt of neoadjuvant chemotherapy, lymph node yield, and utilization of continent urinary diversion. Our objective was to identify the association between hospital type and performance of quality measures using a large national tumor registry. METHODS Using the National Cancer Database (NCDB), all patients with pathologic stage ≥II urothelial carcinoma treated with radical cystectomy (RC) from 2003-2010 were identified. Hospitals were categorized by type and highest annual RC volume tercile into community, comprehensive low volume (CLV), comprehensive high volume (CHV), academic low volume (ALV), and academic high volume (AHV) groups. Generalized estimating equations clustering at the hospital level were used to test the association between hospital group and performance of quality measures (defined as proportion of patients receiving ≥2 quality metrics), adjusting for year, demographic, and clinical/pathologic characteristics. RESULTS 23,279 patients (mean age 67.2±10.8 years, 74% male) meeting study inclusion criteria were treated at community (12.4%), comprehensive (CLV: 38%; CHV: 5%), and academic (ALV: 17%; AHV: 28%) hospitals. Of the entire cohort, 77% of patients were treated ≤90 days, 12% received neoadjuvant chemotherapy, 37% underwent an adequate lymph node dissection (≥12 nodes), and 12% underwent continent urinary diversion. Only 0.2% (n=58) of patients met all 4 proposed criteria, while 5.5%, 31.9%, and 53.6% met 3, 2, and 1 measure respectively. Comparing hospital groups, 53% of patients met the ≥2 quality metric threshold treated at AHV hospitals compared to ALV (36%), CHV (35%), CLV (30%), and community (30%) hospitals respectively (p<0.001). Following adjustment, patients were more likely to meet the ≥2 quality metric threshold when treated at AHV (OR 2.4 [CI 1.9-2.9]), ALV (OR 1.29 [CI 1.1-1.5]), and CHV (OR 1.25 [CI 1.01-1.5]) hospitals compared to community hospitals. Excluding continent diversion as a quality metric did not subtantially alter our main findings. CONCLUSIONS In the NCDB, patients undergoing cystectomy were more likely to meet candidate quality of care measure criteria if treated at academic high volume hospitals. However, adherence to these measures was low across hospital types, highlighting opportunities to improve the quality of care for patients with muscle invasive bladder cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e170-e171 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Corcoran Philadelphia, PA More articles by this author Elizabeth Handorf Philadelphia, PA More articles by this author Daniel Canter Atlanta, GA More articles by this author Justin Beckelman Philadelphia, PA More articles by this author Simon Kim Rochester, MN More articles by this author Serge Ginzburg Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...