Quality improvements are needed to help optimize the implementation of active surveillance among urologists and practice settings, according to a research letter published in JAMA Surgery (published online June 21, 2017; doi:10.1001/jamasurg.2017.1586).
Urologists are increasingly administering active surveillance rather than more aggressive treatments as initial management for men with low-risk prostate cancer due to concerns about overtreatment and adverse events. Progress in active surveillance requires a better understanding of variation across practices and at the individual-level. Whether practice patterns vary among urologists in the same practice or based on his or her panel size is of particular interest for quality improvement interventions.
Gregory B Auffenberg, MD, MS, department of urology, University of Michigan, and colleagues conducted an analysis of Michigan Urological Surgery Improvement Collaborative practices from 2012 to 2016. A total of 124 urologists from 13 practices who managed 2643 patients (median age, 64 years) diagnosed with low-risk prostate cancer were identified. Researchers examined the proportion of men managed primarily with active surveillance across practices and among urologists within each practice. Linear regression model was used to estimate the association between proportion of patients entering active surveillance and urologist panel size.
Median practice and urologist panel size was 165 patients (range, 70-524) and 16 patients (range, 5-141), respectively.
Adjusted proportion of patients entering active surveillance varied significantly across patterns (median, 57.3%; range, 30.2%-72.6%; P < .001). Additionally, researchers reported that urologist-specific use of active surveillance varied significantly in almost all practices. One such practice demonstrated adjusted rates from 0% to 95.6% among more than 30 urologists.
No significant association was found between a urologist’s panel size and rates of active surveillance use.
Researchers concluded that, “The use of AS for primary management of men with low-risk prostate cancer varies widely both across and within urology practices in Michigan; moreover, the propensity to use AS does not appear to correlate with a urologist’s low-risk prostate cancer panel size.”
These findings indicate the quality improvement interventions should be focused on individual physicians, according to researchers.—Zachary Bessette
