Researchers from UCLA and RAND created a comprehensive set of quality-of-care indicators during an 18-month study. The study results appear in the May 15 issue of the peer-reviewed Journal of Clinical Oncology.
"Good care results in better outcomes, but no one knew before how to define good care," said Dr. Mark S. Litwin, a Jonsson Cancer Center researcher, an associate professor of urology, a RAND consultant and the article's senior author. "That's what this paper does, establish what good care means in early-stage prostate cancer."
The study does not set out to determine which treatment is best for early-stage prostate cancer -- still a matter of considerable debate among physicians. Instead, the study focuses on where to go for the best care once a patient makes a treatment decision.
"Quality of care really does vary," Litwin said. "The indicators we developed will allow for the thoughtful creation of report cards that patients and primary-care physicians can use to make important decisions. This should help answer questions like 'Should I get on a plane and fly out to UCLA for this procedure or can I get comparable care here at home?'"
Researchers looked at surgery and external beam radiation treatment in assembling the quality-of-care indicators. Brachytherapy, the implantation of radioactive seeds into the prostate, was not widely available when the study was launched, so they did not include that procedure, Litwin said. Researchers plan to develop a set of indicators for brachytherapy later.
Measuring and assessing quality of care in medicine is a relatively new field, Litwin said. Until this study, little work had been done to quantify the quality of care in early-stage prostate cancer patients.
"This study for the first time shows that elements of prostate cancer care can be quantified, and such measurements can help patients make the best treatment decisions," Litwin said.
Indicators established by the study to measure quality of care include patient volume (caseload), pre-treatment referrals and consultations, preoperative testing, interpretation of pathology specimens, availability of psychological counseling resources and such factors as disease-free survival times, patient satisfaction, length of hospital stay and surgical complications.
The next step, Litwin said, is to take these indicators out into the field and apply them to medical institutions to determine how well they're doing. Report cards rating the institutions can then be compiled and made available to patients and physicians.
"In fact, the choice of provider may be as important as the choice of treatment," the journal article states.
Although the quality-of-care indicators developed by Litwin and his team apply only to early-stage prostate cancer, Litwin said they could be adapted to quantify care for other forms of cancer.
RAND Health is the nation's largest independent health-policy research organization, with a broad research portfolio that focuses on medical quality, health-care costs and delivery of health care, among other topics.
The Journal of Clinical Oncology is the official journal of the American Society of Clinical Oncology. For more information, visit www.jco.org.
Visit www.cancer.mednet.ucla.edu for more information on UCLA's Jonsson Cancer Center.