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114 AHRQ PATIENT SAFETY INDICATORS (PSIS) AND UROLOGIC CANCER HOSPITALIZATIONS
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
adjustment for covariates like age, gender and comorbidities. This consideration should be taken into account when best therapeutic options are considered. Source of Funding: None
114 AHRQ PATIENT SAFETY INDICATORS (PSIS) AND UROLOGIC CANCER HOSPITALIZATIONS Veerasathpurush Allareddy, Boston, MA; Badrinath Konety*, Minneapolis, MN INTRODUCTION AND OBJECTIVES: Patient safety indicators (PSI) are a set of measures developed by the Agency for Healthcare Research and Quality (AHRQ) as identifiable through administrative data from inpatient hospital discharges. They screen for presumably avoidable adverse events experienced by patients during a hospital stay and their occurrence could potentially be prevented by interventions at the provider or system level. We examined the prevalence of PSIs in patients admitted with urologic cancer diagnoses and attempted to characterize the factors that may contribute to the frequency with which they are observed. METHODS: We examined the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project family of datasets from year 2006 for the study. NIS data consists of a 20% sample of inpatient discharge data from 38 states and 1044 hospitals and include a wide range of payer mix. All discharges with a principal diagnosis of prostate, bladder or kidney cancer were identified through ICD -9CM codes. PSIs were identified according to the list published by AHRQ. Chi square analysis with a p⬍0.05 being considered significant was used to assess if hospital bedsize, teaching status and location (rural/ urban) were associated with increased frequency of PSIs. RESULTS: Death among patients with treatable complications was the PSI with highest frequency (10.6%) followed by accidental puncture/laceration (1.54%), decubitus ulcers (1.15%), post-operative respiratory failure (1.06%), Deep Vein Thrombosis/Pulmonary Embolism [DVT/PE] (0.81%). Accidental puncture/laceration was more frequently observed in larger bedsized hospitals (1.7% in large bed hospitals vs 1.3% in medium bed and 1.1% in small bed size hospitals p⫽0.007) as was metabolic derangement (0.3% in large bed hospitals vs 0.1% in medium bed p⫽0.001). Decubitus ulcer was more common in rural hospitals compared to urban hospitals (2.7% in rural vs. 1% in urban, p⬍0.0001). Post-operative DVT/PE was more commonly observed in teaching hospitals (0.9% in teaching vs. 0.7% in non-teaching, p⫽0.04). The prevalence of the other PSIs did not vary based on hospital characteristics. CONCLUSIONS: The prevalence of PSIs among patients with urologic cancer diagnoses is low. Some PSIs tend to occur more frequently in rural, teaching or larger bedsized hospitals. This may be a reflection of the complexity of the cases treated at these hospitals rather than the quality of the hospitals. These data raise the issue of the relevance of the PSIs as reliable quality indicators in urologic cancer patients and the need to interpret them in the context of case mix attributes. Source of Funding: None
115 RACIAL AND ETHNIC DISPARITY IN QUALITY OF CARE AMONG ELDERLY PROSTATE CANCER PATIENTS Ravishankar Jayadevappa*, Sumedha Chhatre, J. Sanford Schwartz, J. Sanford Schwartz, Jerry Johnson, S. Bruce Malkowicz, Philadelphia, PA INTRODUCTION AND OBJECTIVES: We sought to analyze racial and ethnic disparity in quality of care of elderly prostate cancer patients after controlling for clinical and socioeconomic covariates. METHODS: Retrospective case-control design using SEERMedicare databases for the period between 1995 and 2003. Prostate
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cancer patients were identified and retrospectively followed for one year pre and up to eight years post diagnosis. Parametric and nonparametric analyses were used to compare 30 and 90 days quality of care outcomes across racial and ethnic groups. Poisson regression (with zero inflation correction) and Cox survival models were used to assess the association between quality of care outcomes and race, after adjusting for covariates. Geographic based instrumental variable approach was used to account for unmeasured bias. RESULTS: We identified 40,876 Caucasian, 5,867 African American and 3,034 Hispanic men newly diagnosed for prostate cancer. Mean time to treatment was high for African American group compared to Caucasian and Hispanic group (134, 99 and 89 days respectively, p⬍.0001). Quality of care measures (ER visits, complications, readmissions and mortality) showed significant variation across racial and ethnic groups. Poisson regression indicated that African American group was associated with higher odds of ER and inpatient visits (OR⫽1.06, p⫽0.0006 and OR⫽1.3, p⬍.0001, respectively) within 30 days of treatment. Hispanic group had lower odds of such visits (OR⫽0.85, p⬍.0001 and OR⫽0.87, p⫽0.004, respectively). Cox survival analysis for mortality indicated higher hazard associated with African American group (HR⫽1.124, p ⬍.0001) after controlling for demographic and clinical covariates. CONCLUSIONS: We developed a conceptual model to identify the factors associated with quality of care measures among prostate cancer patients. African American ethnicity was associated with poorer quality of prostate cancer care. Source of Funding: Supported in part by the National Cancer Institute, National Institutes of Health-Grant # 5RO3CA 121338-2.
116 ESTABLISHMENT OF A UROLOGICAL SURGERY QUALITY COLLABORATIVE David Miller*, Ann Arbor, MI; Dan Murtagh, Toledo, OH; Peter Knapp, Ronald Suh, Indianapolis, IN; Rodney Dunn, James Montie, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: Recognizing the promising results achieved with physician-led quality collaboratives in other clinical disciplines, we established the Urological Surgery Quality Collaborative (USQC) with the intent of bringing together a broad coalition of urology practices interested in carrying out quality improvementoriented clinical projects. Herein, we describe our pilot project aimed at improving radiographic staging practices among men with newly-diagnosed prostate cancer (CaP). METHODS: The USQC comprises more than 60 urologists from three large group practices. From May through September 2009, surgeons in each group collected a uniform set of data for men with newly-diagnosed CaP, including PSA level, clinical T stage, biopsy Gleason score, receipt (and results) of staging bone scan and/or CT scan, and whether the treatment plan was altered based on imaging results. Coordinators at each practice faxed completed data collection forms to a central computer, where commercially-available software converted written information to electronic data. For analytic purposes, we categorized each patient’s cancer as low-, intermediate-, or highrisk based on the D’Amico classification. We then performed stratifed analyses to evaluate utilization of staging studies across CaP risk strata and USQC practice locations. RESULTS: We collected data for 315 men with CaP, including at least 30 cases from each practice. Among this cohort, 34%, 42%, and 24% had low-, intermediate-, and high-risk cancers, respectively. Overall, 44% and 43% of patients underwent staging with a bone scan or CT scan, respectively; only 9% and 7% (respectively) of these studies were positive for metastases. The use of staging studies increased in synchrony with risk strata: bone scans or CT scans were performed, respectively, in 17% and 18%, 41% and 40%, and 88% and 86% of patients with low-, intermediate- and high-risk tumors (pvalues⬍0.01). For men with low-risk CaP, use of both bone scans and
adjustment for covariates like age, gender and comorbidities. This consideration should be taken into account when best therapeutic options are considered. Source of Funding: None
114 AHRQ PATIENT SAFETY INDICATORS (PSIS) AND UROLOGIC CANCER HOSPITALIZATIONS Veerasathpurush Allareddy, Boston, MA; Badrinath Konety*, Minneapolis, MN INTRODUCTION AND OBJECTIVES: Patient safety indicators (PSI) are a set of measures developed by the Agency for Healthcare Research and Quality (AHRQ) as identifiable through administrative data from inpatient hospital discharges. They screen for presumably avoidable adverse events experienced by patients during a hospital stay and their occurrence could potentially be prevented by interventions at the provider or system level. We examined the prevalence of PSIs in patients admitted with urologic cancer diagnoses and attempted to characterize the factors that may contribute to the frequency with which they are observed. METHODS: We examined the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project family of datasets from year 2006 for the study. NIS data consists of a 20% sample of inpatient discharge data from 38 states and 1044 hospitals and include a wide range of payer mix. All discharges with a principal diagnosis of prostate, bladder or kidney cancer were identified through ICD -9CM codes. PSIs were identified according to the list published by AHRQ. Chi square analysis with a p⬍0.05 being considered significant was used to assess if hospital bedsize, teaching status and location (rural/ urban) were associated with increased frequency of PSIs. RESULTS: Death among patients with treatable complications was the PSI with highest frequency (10.6%) followed by accidental puncture/laceration (1.54%), decubitus ulcers (1.15%), post-operative respiratory failure (1.06%), Deep Vein Thrombosis/Pulmonary Embolism [DVT/PE] (0.81%). Accidental puncture/laceration was more frequently observed in larger bedsized hospitals (1.7% in large bed hospitals vs 1.3% in medium bed and 1.1% in small bed size hospitals p⫽0.007) as was metabolic derangement (0.3% in large bed hospitals vs 0.1% in medium bed p⫽0.001). Decubitus ulcer was more common in rural hospitals compared to urban hospitals (2.7% in rural vs. 1% in urban, p⬍0.0001). Post-operative DVT/PE was more commonly observed in teaching hospitals (0.9% in teaching vs. 0.7% in non-teaching, p⫽0.04). The prevalence of the other PSIs did not vary based on hospital characteristics. CONCLUSIONS: The prevalence of PSIs among patients with urologic cancer diagnoses is low. Some PSIs tend to occur more frequently in rural, teaching or larger bedsized hospitals. This may be a reflection of the complexity of the cases treated at these hospitals rather than the quality of the hospitals. These data raise the issue of the relevance of the PSIs as reliable quality indicators in urologic cancer patients and the need to interpret them in the context of case mix attributes. Source of Funding: None
115 RACIAL AND ETHNIC DISPARITY IN QUALITY OF CARE AMONG ELDERLY PROSTATE CANCER PATIENTS Ravishankar Jayadevappa*, Sumedha Chhatre, J. Sanford Schwartz, J. Sanford Schwartz, Jerry Johnson, S. Bruce Malkowicz, Philadelphia, PA INTRODUCTION AND OBJECTIVES: We sought to analyze racial and ethnic disparity in quality of care of elderly prostate cancer patients after controlling for clinical and socioeconomic covariates. METHODS: Retrospective case-control design using SEERMedicare databases for the period between 1995 and 2003. Prostate
THE JOURNAL OF UROLOGY姞
e47
cancer patients were identified and retrospectively followed for one year pre and up to eight years post diagnosis. Parametric and nonparametric analyses were used to compare 30 and 90 days quality of care outcomes across racial and ethnic groups. Poisson regression (with zero inflation correction) and Cox survival models were used to assess the association between quality of care outcomes and race, after adjusting for covariates. Geographic based instrumental variable approach was used to account for unmeasured bias. RESULTS: We identified 40,876 Caucasian, 5,867 African American and 3,034 Hispanic men newly diagnosed for prostate cancer. Mean time to treatment was high for African American group compared to Caucasian and Hispanic group (134, 99 and 89 days respectively, p⬍.0001). Quality of care measures (ER visits, complications, readmissions and mortality) showed significant variation across racial and ethnic groups. Poisson regression indicated that African American group was associated with higher odds of ER and inpatient visits (OR⫽1.06, p⫽0.0006 and OR⫽1.3, p⬍.0001, respectively) within 30 days of treatment. Hispanic group had lower odds of such visits (OR⫽0.85, p⬍.0001 and OR⫽0.87, p⫽0.004, respectively). Cox survival analysis for mortality indicated higher hazard associated with African American group (HR⫽1.124, p ⬍.0001) after controlling for demographic and clinical covariates. CONCLUSIONS: We developed a conceptual model to identify the factors associated with quality of care measures among prostate cancer patients. African American ethnicity was associated with poorer quality of prostate cancer care. Source of Funding: Supported in part by the National Cancer Institute, National Institutes of Health-Grant # 5RO3CA 121338-2.
116 ESTABLISHMENT OF A UROLOGICAL SURGERY QUALITY COLLABORATIVE David Miller*, Ann Arbor, MI; Dan Murtagh, Toledo, OH; Peter Knapp, Ronald Suh, Indianapolis, IN; Rodney Dunn, James Montie, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: Recognizing the promising results achieved with physician-led quality collaboratives in other clinical disciplines, we established the Urological Surgery Quality Collaborative (USQC) with the intent of bringing together a broad coalition of urology practices interested in carrying out quality improvementoriented clinical projects. Herein, we describe our pilot project aimed at improving radiographic staging practices among men with newly-diagnosed prostate cancer (CaP). METHODS: The USQC comprises more than 60 urologists from three large group practices. From May through September 2009, surgeons in each group collected a uniform set of data for men with newly-diagnosed CaP, including PSA level, clinical T stage, biopsy Gleason score, receipt (and results) of staging bone scan and/or CT scan, and whether the treatment plan was altered based on imaging results. Coordinators at each practice faxed completed data collection forms to a central computer, where commercially-available software converted written information to electronic data. For analytic purposes, we categorized each patient’s cancer as low-, intermediate-, or highrisk based on the D’Amico classification. We then performed stratifed analyses to evaluate utilization of staging studies across CaP risk strata and USQC practice locations. RESULTS: We collected data for 315 men with CaP, including at least 30 cases from each practice. Among this cohort, 34%, 42%, and 24% had low-, intermediate-, and high-risk cancers, respectively. Overall, 44% and 43% of patients underwent staging with a bone scan or CT scan, respectively; only 9% and 7% (respectively) of these studies were positive for metastases. The use of staging studies increased in synchrony with risk strata: bone scans or CT scans were performed, respectively, in 17% and 18%, 41% and 40%, and 88% and 86% of patients with low-, intermediate- and high-risk tumors (pvalues⬍0.01). For men with low-risk CaP, use of both bone scans and