Process Risk Assessment Risk assessment: family history assessment of family history of prostate cancer Best Observed: 97 %1 ; Ideal Benchmark:100% measure P8 2 Process Appropriateness of Care Pre-treatment urinary, sexual, and bowel function pretreatment urinary, sexual, and bowel function assessed using a validated instrument RAND Average: Pretreatment urinary function 82-90%, Pre-treatment sexual function 42-55% 3 ; Ideal Benchmark: 100% measure P39 4 PSA surveillance Percentage of patients that have had their PSA levels measured in the past 12 months Active Health Reported Average: 80 %5 ; Ideal Benchmark: 100% of eligible patients NQF #0625 6 Adjuvant hormonal therapy for high-risk patients Percentage of patients at high risk of prostate cancer recurrence receiving external beam radiotherapy to the prostate who were prescribed adjuvant hormonal therapy (GnRH agonist or antagonist) 25th percentile: 0.00% 50th percentile: 7.69% 75th percentile: 22.22% 90th percentile: 50.00% 7 AMA-PCPI 8, NQF #0390 9 Three-dimensional radiotherapy prostate cancer receiving external beam radiotherapy to the prostate only who receive 3D-CRT (threedimensional conformal radiotherapy) or IMRT (intensity modulated radiation therapy) 25th percentile: 4.83% 50th percentile: 41.10% 75th percentile: 76.00% 90th percentile: 97.46% 10 AMA-PCPI 11, NQF #0388 12 Avoidance of overuse of bone scan for staging lowrisk patients Percentage of patients at low risk of prostate cancer recurrence, receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer 25th percentile: 0.00% 50th percentile: 1.36% 75th percentile: 35.00% 90th percentile: 77.63% 13 AMA-PCPI 14, NQF #0389 15 Process Patient-Centered Care Informed decision making Percentage of patients that consulted with urologist and radiation oncologist Best Observed: 100% of patients 16 ; Ideal Benchmark: 100% of eligible patients Patient assessment of QOL post-treatment Percentage of patients assessed for urinary, sexual, and bowel function post-treatment using validated survey instrument Best observed: 79 %17; Ideal Benchmark: 100% of patients completed assessment measure O11 18 Patient satisfaction with treatment choice Percentage of patients satisfied with general results of treatment decision (would make same decision again) Highly variable, overall observed average: 92%, radiation therapy: 94%, radical prostatectomy 91% 19 measure O17 20 22
Process Documentation Completeness Documentation of pre-treatment evaluation documentation of pre-treatment DRE, PSA, gleason score RAND Average: Documented DRE 79-90% of patients, Documented pre-treatment PSA 93-98%; Ideal Benchmark: 100% for each metric 21 measure P1 22 Pathology report completeness Percentage of pathology reports containing data elements specified by the College of American Pathologists surgical case summary CAP Quality Probe average: 88.4% of pathology reports complete; ACoS/CoC Requirement: 90% of pathology reports include required data elements as per CAP protocol 23, Ideal benchmark: 100% ACoS/CoC, CAP 24, RAND Endorsed Quality of Care measure P15 25 Staging completeness complete TNM staging in medical record Average: Documented TNM 65-93% 26 ; NCRA standard: at least 90% of eligible annual patient cases must contain TNM staging in medical record 27 NCRA Standard 4.3 28, RAND Endorsed Quality of Care measure P31 29 Radical Prostatectomy Pathology Reporting Outcome Percentage of radical prostatectomy pathology reports that include the pt category, the pn category, the Gleason score and a statement about margin status Ideal Benchmark: 100% NQF #1853 30, CAP 31 Operative blood loss ml of blood loss during radical prostatectomy Radical Retropubic Prostatectomy: 664 ml, Robot-assisted Laparoscopic Prostatectomy: 191 ml 32 measure P28 33 Surgical margin positivity rate Percentage of radical prostatectomy patients with positive surgical margins Average performance: 34% Best Observed: 10% 34 Radiation therapy complications resulting in inpatient stay Hospitalization, medical or surgical treatment, for cystitis, proctitis, hematuria or rectal bleeding No external benchmarks available; benchmark internally O6, O7 35 Bladder neck contracture After radiation therapy or radical prostatectomy: treatment for bladder neck or urethral stricture Overall stricture treatment rate: 5.2% of prostate cancer cases, Radical Prostatectomy: 8.4% of patients experienced stricture, Brachytherapy: 1.8% of patients experienced stricture, External Beam Radiotherapy: 1.7% of patients experienced stricture 36 Measures O8, O9, O10 37 23
Outcome Proctitis Percentage of patients experiencing acute proctitis after radiation therapy IGRT (Image guided radiotherapy): 6%, non- IGRT 15% 38 O6, O7 39 Cystitis Percentage of patients experiencing acute cystitis after radiation therapy IGRT (Image guided radiotherapy): 47% of patients grade 2 toxicity, 1% grade 3 toxicity, non- IGRT: 42% of patients grade 2 toxicity, 4% grade 3 toxicity 40 O6, O7 41 Health related QOL QOL domain-specific distress; percentage of patients reporting moderate to big problems in specific QOL domain Observed Average: Sexual function: Prostatectomy 50% Radiotherapy 31% Brachytherapy 30% Urinary incontinence: Prostatectomy 8% Radiotherapy 4% Brachytherapy 5% Urinary irritation or obstruction: Prostatectomy 12% Radiotherapy 14% Brachytherapy 18% Bowel or rectal function: Prostatectomy 2% Radiotherapy 11% Brachytherapy 10% Vitality or hormonal function: Prostatectomy 9% Radiotherapy 18% Brachytherapy 15% 42 24
Sources 1,16. Spencer BA, et al., Quality-of-care indicators for early stage prostate cancer, Journal of Clinical Oncology, 2003, 21(10):1928-36; Miller DC, et al., Use of quality indicators to evaluate the care of patients with localized prostate cancer, Cancer, 2003, 97(6):1428-35. 2. Measure P8, Assessment of family history of prostate cancer, available at: d=0ccaqfjaa&url=http%3a%2f%2fwww.qualityforum.org%2fworkare a%2flinkit.aspx%3flinkidentifier%3did%26itemid%3d70253&ei=ei1sui T1Narr0gG6x4GoCQ&usg=AFQjCNGNCkaf2MFzEp_xTH5k0M3vjba5qQ &sig2=y8q-ptera5roy5qom4ktag, last accessed September 2012. 15. National Quality Forum, NQF Endorsed Measure #0389, Prostate cancer: Avoidance of overuse measure bone scan for staging low-risk patients, available at: http://www.qualityforum.org/qps/, last accessed: June 2012. 3. Miller DC, et al., "Quality of care indicators for prostate cancer: Progress toward consensus," Urologic Oncology: Seminars and Original Investigations, 2009, 27(4):427-434. 4. Measure P39, Pre-treatment urinary, sexual, and bowel function, available at: 5. ActiveHealth Management, Measure Submission and Evaluation Worksheet 5.0: NQF #0625, available at: d=0ccaqfjaa&url=http%3a%2f%2fwww.qualityforum.org%2fworkare a%2flinkit.aspx%3flinkidentifier%3did%26itemid%3d70255&ei=acfsu OOGFKjF0QGj0YHAAw&usg=AFQjCNHKfV0V2YOtNpCTlXbSh6QxTf4M dq&sig2=oxyfcas2kso5l4zoqiemdg, last accessed: September 2012. 6. National Quality Forum, NQF Endorsed Measure #0625, History of prostate cancer - Cancer surveillance, available at: http://www.qualityforum.org/qps/, last accessed July 2012. 17. Spencer BA, et al., Quality-of-care indicators for early stage prostate cancer, Journal of Clinical Oncology, 2003, 21(10):1928-1936; Miller DC et al., Use of quality indicators to evaluate the care of patients with localized prostate cancer, Cancer, 2003, 97(6):1428-1435; Oncology Roundtable interviews. 18. RAND, RAND endorsed quality of care measure O11: Patient assessment of urinary, sexual, and bowel functioning following primary treatment by radiation therapy or radical prostatectomy, using a reliable, validated survey instrument, available at: 19. Spencer BA, et al., Quality-of-care indicators for early stage prostate cancer, Journal of Clinical Oncology, 2003, 21(10):1928-1936; Miller DC, et al., Use of quality indicators to evaluate the care of patients with localized prostate cancer, Cancer, 2003, 97(6):1428-1435; Hoffman RM, et al., Patient satisfaction with treatment decisions for clinically localized prostate carcinoma; Results from the prostate cancer outcomes study, Cancer, 2001, 97(7):1653-1662; Oncology Roundtable interviews. 7,8. American Medical Association Physician Consortium for worksheet 5.0: NQF #0390, available at: d=0cciqfjaa&url=http%3a%2f%2fwww.qualityforum.org%2fworkarea %2Flinkit.aspx%3FLinkIdentifier%3Did%26ItemID%3D70254&ei=hx1SUJj BKbGy0QHnqoDoBw&usg=AFQjCNH2HTklRwt34shcqCAe7j1xfaHxg&sig2=66N0hXpO-CNsgOlAbVHD3Q, last accessed: September 2012. 9. National Quality Forum, NQF Endorsed Measure #0390, Adjuvant hormonal therapy for high-risk patients, available at: http://www.qualityforum.org/qps/, last accessed: June 2012. 10,11. American Medical Association Physician Consortium for worksheet 5.0: NQF #0388, available at: d=0cciqfjaa&url=http%3a%2f%2fwww.qualityforum.org%2fworkarea %2Flinkit.aspx%3FLinkIdentifier%3Did%26ItemID%3D70259&ei=tipSUKb KMc2H0QHKmYHYCQ&usg=AFQjCNGRpU4Ncf8c8rxv8WozMWQJ4iSpj Q&sig2=2LzYm-m_CHDHvLv7Z3AHlA, last accessed: September 2012. 12. National Quality Forum, NQF Endorsed Measure #0388, Prostate cancer: Three-dimensional radiotherapy, available at: http://www.qualityforum.org/qps/, last accessed July 2012. 13,14. American Medical Association Physician Consortium for worksheet 5.0: NQF #0389, available at: 20. RAND, RAND endorsed quality of care measure O17: Patient satisfaction with treatment choice, available at: 21,26. Miller DC, et al., "Quality of care indicators for prostate cancer: Progress toward consensus," Urologic Oncology: Seminars and Original Investigations, 2009, 27(4):427-434. 22. RAND, RAND endorsed quality of care measure P1: Pre-treatment clinical staging with digital rectal exam (DRE), total PSA, Gleason grade, available at: accessed July 2012. 23,24,31. Idowu MO, et al., "Adequacy of surgical pathology reporting of cancer: A college of American pathologists q-probes study of 86 institutions," Archives of Pathology and Laboratory Medicine, 2012, 134(7):969-974, available at: http://www.sciencedirect.com/science/article/pii/s1072751508003256, last accessed: June 2012. 25. RAND, RAND endorsed quality of care measure P15: Evidence of institutional adherence to practice protocol of the College of American Pathologists Cancer Committee for managements of pathology specimens, available at: 25
Sources 27,28. National Cancer Registrar's Association, NCRA endorsed standard 4.3: Achieving physician staging compliance, available at: http://www.ncra-usa.org/files/public/hospitalcompliance.pdf, last accessed: August 2012. 29. RAND, RAND endorsed quality of care measure P31: Use of clinical and pathological Tumor-Nodes-Metastasis (TNM) staging by the treating physicians, available at 30. National Quality Forum, NQF endorsed measure #0389: Radical prostatectomy pathology reporting, available at: http://www.qualityforum.org/qps/, last accessed: August 2012. Medical treatment for bladder neck contracture/urethral stricture following radical prostatectomy or radiation therapy, available at 38,40. Gill S, et al., 2011. "Acute toxicity in prostate cancer patients treated with and without image-guided radiotherapy," Radiation Oncology, 2011, 28(6):145 42. Sanda MG, et al., Quality of life and satisfaction with outcome among prostate cancer survivors, The New England Journal of Medicine, 2008, 358:1250-61. 32. Farnham SB, et al., "Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy," Urology, 2006, 67(2)360-3, available at: http://www.sciencedirect.com/science/article/pii/s0090429505011854, last accessed: August 2012. 33. RAND, RAND endorsed quality of care measure P28: Operative blood loss, available at: 34. Eastham JA, et al., Variations among individual surgeons in the rate of positive surgeon margins in radical prostatectomy specimens, Journal of Urology, 2003, 170(6 Pt.1):2292-5; Cooperburg MR, et al., The contemporary management of prostate cancer in the United States: Lessons from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPsure), a national disease registry, The Journal of Urology, 2004, 171:1393-1401. 35,39,41. RAND, Measure O5: Hospitalization for cystitis, proctitis, hematuria, rectal bleeding following primary treatment by radiation therapy, available at: accessed July 2012; RAND, Measure O6: Surgical treatment for cystitis, proctitis, hematuria, rectal bleeding following primary treatment by radiation therapy, available at: accessed July 2012; RAND, Measure O7: Medical treatment for cystitis, proctitis, hematuria, rectal bleeding following primary treatment by radiation therapy, available at: accessed July 2012. 36. Elliott, SP, et al., "Incidence of urethral stricture after primary treatment for prostate cancer: Data from CaPSURE," Journal of Urology, 2007, 178(2):529-34. 37. RAND, Measure O8: Hospitalization for bladder neck contracture/urethral stricture following radical prostatectomy or radiation therapy, available at: accessed: July 2012; RAND, RAND endorsed quality of care measure O9: Surgical treatment for bladder neck contracture/urethral stricture following radical prostatectomy or radiation therapy, available at accessed: July 2012; RAND endorsed quality of care measure O10: 26