Pd13-06 Implementation of Practice-Level Interventions for Low-Risk Prostate Cancer in a Community Practice

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13) 1 May 2024PD13-06 IMPLEMENTATION OF PRACTICE-LEVEL INTERVENTIONS FOR LOW-RISK PROSTATE CANCER IN A COMMUNITY PRACTICE Franklin D. Gaylis, Michael Leapman, Shellie D. Ellis, Steven Hu, Matthew R. Cooperberg, Stacy Loeb, Ronald C. Chen, Edward S. Cohen, Paul E. Dato, Shahrad Aynehchi, Richard David, Robert Topp, and William Catalona Franklin D. GaylisFranklin D. Gaylis, Michael LeapmanMichael Leapman, Shellie D. EllisShellie D. Ellis, Steven HuSteven Hu, Matthew R. CooperbergMatthew R. Cooperberg, Stacy LoebStacy Loeb, Ronald C. ChenRonald C. Chen, Edward S. CohenEdward S. Cohen, Paul E. DatoPaul E. Dato, Shahrad AynehchiShahrad Aynehchi, Richard DavidRichard David, Robert ToppRobert Topp, and William CatalonaWilliam Catalona View All Author Informationhttps: //doi. org/10. 1097/01. JU. 0001009552. 62973. 71. 06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Optimal interventions to promote the uptake of active surveillance (AS) for low-risk prostate cancer, an underutilized guideline-based practice, particularly in community-based urology practices remain under-explored. With the goal of increasing the adoption and the quality of AS care for low-risk prostate cancer (LR PCa), we studied the effect of a combined implementation strategy in community practice. METHODS: We examined a pay-for-performance (P4P) and audit and feedback (transparency) intervention in 3 California urology practices (1/2/22-12/31/22) including new (incident) and existing (prevalent) patients on AS. The payor, United Healthcare (UHC) and the practitioners developed evidence-based quality measures and thresholds: 75% adoption of AS and watchful waiting (WW) for LR PCa, 90% documentation of risk and management, 75% adherence to PSA testing and confirmatory biopsy. Physician performance was transparently shared. Baseline (2019) risk assessment and management data were manually abstracted. Electronic data retrieval from structured templates and clinical notes was performed in 2022. Primary outcome was practice-level selection of AS/WW; secondary outcomes included adherence to AS quality measures. Manual versus automated electronic data acquisition costs were compared. RESULTS: The adoption of conservative management of LR PCa patients increased from 65% in 2019 to 83% in 2022 (p<. 001). Table 1 shows the quality measure adherence according to payor type. During the 2022 intervention, 82% of non-UHC, 92% of UHC non-P4P, and 100% of UHC P4P patients adopted AS/WW. For prevalent patients, 65 % UHC non-P4P and 90% UHC P4P patients received≥2 PSA tests within one year, and 2 of 4 UHC non-P4P and the only UHC P4P patient with LR PCa had a confirmatory biopsy within 18 months. The estimated total cost for manual data abstraction for 1200 patients was 21, 680 versus a one-time cost of 222, 090 to build the automated electronic platform with an ongoing annual cost of 1200. CONCLUSIONS: The use of a practice-level financial incentive and transparency was associated with improved uptake and quality of AS for low-risk prostate cancer. Larger studies on a national scale are warranted to examine behavioral interventions to improve the adoption and quality of evidence-based care for PCa patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc. FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e264 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc. Metrics Author Information Franklin D. Gaylis More articles by this author Michael Leapman More articles by this author Shellie D. Ellis More articles by this author Steven Hu More articles by this author Matthew R. Cooperberg More articles by this author Stacy Loeb More articles by this author Ronald C. Chen More articles by this author Edward S. Cohen More articles by this author Paul E. Dato More articles by this author Shahrad Aynehchi More articles by this author Richard David More articles by this author Robert Topp More articles by this author William Catalona More articles by this author Expand All Advertisement PDF downloadLoading. . .