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A Statewide Intervention Improves Appropriate Imaging in Localized Prostate Cancer.

Identifieur interne : 000A94 ( Main/Exploration ); précédent : 000A93; suivant : 000A95

A Statewide Intervention Improves Appropriate Imaging in Localized Prostate Cancer.

Auteurs : Patrick Hurley ; Apoorv Dhir ; Yuqing Gao ; Brian Drabik ; Kenneth Lim ; Jon Curry ; Paul R. Womble ; Susan M. Linsell ; Andrew Brachulis ; Donald W. Sexton ; Khurshid R. Ghani ; Brian T. Denton ; David C. Miller ; James E. Montie

Source :

RBID : pubmed:27889418

Descripteurs français

English descriptors

Abstract

PURPOSE

We implemented a statewide intervention to improve imaging utilization for the staging of patients with newly diagnosed prostate cancer.

MATERIALS AND METHODS

MUSIC (Michigan Urological Surgery Improvement Collaborative) is a quality improvement collaborative comprising 42 diverse practices representing approximately 85% of the urologists in Michigan. MUSIC has developed imaging appropriateness criteria (prostate specific antigen greater than 20 ng/ml, Gleason score 7 or higher and clinical stage T3 or higher) which minimize unnecessary imaging with bone scan and computerized tomography. After baseline rates of radiographic staging were established in 2012 and 2013, we used multidimensional interventions to deploy these criteria in 2014. Imaging utilization was then remeasured in 2015 to evaluate for changes in practice patterns.

RESULTS

A total of 10,554 newly diagnosed patients with prostate cancer were entered into the MUSIC registry from January 1, 2012 through December 31, 2013 and January 1, 2015 through December 31, 2015. Of these patients 7,442 (79%) and 7,312 (78%) met our criteria to avoid bone scan and computerized tomography imaging, respectively. The use of bone scan imaging when not indicated decreased from 11.0% at baseline to 6.5% after interventions (p <0.0001). The use of computerized tomography when not indicated decreased from 14.7% at baseline to 7.7% after interventions (p <0.0001). Variability among practices decreased substantially after the interventions as well. The use of recommended imaging remained stable during these periods.

CONCLUSIONS

An intervention aimed at appropriate use of imaging was associated with decreased use of bone scans and computerized tomography among men at low risk for metastases.


DOI: 10.1016/j.juro.2016.11.098
PubMed: 27889418


Affiliations:


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Le document en format XML

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<b>PURPOSE</b>
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<p>We implemented a statewide intervention to improve imaging utilization for the staging of patients with newly diagnosed prostate cancer.</p>
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<b>MATERIALS AND METHODS</b>
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<p>MUSIC (Michigan Urological Surgery Improvement Collaborative) is a quality improvement collaborative comprising 42 diverse practices representing approximately 85% of the urologists in Michigan. MUSIC has developed imaging appropriateness criteria (prostate specific antigen greater than 20 ng/ml, Gleason score 7 or higher and clinical stage T3 or higher) which minimize unnecessary imaging with bone scan and computerized tomography. After baseline rates of radiographic staging were established in 2012 and 2013, we used multidimensional interventions to deploy these criteria in 2014. Imaging utilization was then remeasured in 2015 to evaluate for changes in practice patterns.</p>
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<b>RESULTS</b>
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<p>A total of 10,554 newly diagnosed patients with prostate cancer were entered into the MUSIC registry from January 1, 2012 through December 31, 2013 and January 1, 2015 through December 31, 2015. Of these patients 7,442 (79%) and 7,312 (78%) met our criteria to avoid bone scan and computerized tomography imaging, respectively. The use of bone scan imaging when not indicated decreased from 11.0% at baseline to 6.5% after interventions (p <0.0001). The use of computerized tomography when not indicated decreased from 14.7% at baseline to 7.7% after interventions (p <0.0001). Variability among practices decreased substantially after the interventions as well. The use of recommended imaging remained stable during these periods.</p>
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<b>CONCLUSIONS</b>
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<AbstractText Label="RESULTS">A total of 10,554 newly diagnosed patients with prostate cancer were entered into the MUSIC registry from January 1, 2012 through December 31, 2013 and January 1, 2015 through December 31, 2015. Of these patients 7,442 (79%) and 7,312 (78%) met our criteria to avoid bone scan and computerized tomography imaging, respectively. The use of bone scan imaging when not indicated decreased from 11.0% at baseline to 6.5% after interventions (p <0.0001). The use of computerized tomography when not indicated decreased from 14.7% at baseline to 7.7% after interventions (p <0.0001). Variability among practices decreased substantially after the interventions as well. The use of recommended imaging remained stable during these periods.</AbstractText>
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<Keyword MajorTopicYN="Y">prostatic neoplasms</Keyword>
<Keyword MajorTopicYN="Y">quality improvement</Keyword>
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<Year>2016</Year>
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<Year>2016</Year>
<Month>11</Month>
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<Hour>6</Hour>
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<PublicationStatus>ppublish</PublicationStatus>
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<ArticleId IdType="pubmed">27889418</ArticleId>
<ArticleId IdType="pii">S0022-5347(16)31860-2</ArticleId>
<ArticleId IdType="doi">10.1016/j.juro.2016.11.098</ArticleId>
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<name sortKey="Brachulis, Andrew" sort="Brachulis, Andrew" uniqKey="Brachulis A" first="Andrew" last="Brachulis">Andrew Brachulis</name>
<name sortKey="Curry, Jon" sort="Curry, Jon" uniqKey="Curry J" first="Jon" last="Curry">Jon Curry</name>
<name sortKey="Denton, Brian T" sort="Denton, Brian T" uniqKey="Denton B" first="Brian T" last="Denton">Brian T. Denton</name>
<name sortKey="Dhir, Apoorv" sort="Dhir, Apoorv" uniqKey="Dhir A" first="Apoorv" last="Dhir">Apoorv Dhir</name>
<name sortKey="Drabik, Brian" sort="Drabik, Brian" uniqKey="Drabik B" first="Brian" last="Drabik">Brian Drabik</name>
<name sortKey="Gao, Yuqing" sort="Gao, Yuqing" uniqKey="Gao Y" first="Yuqing" last="Gao">Yuqing Gao</name>
<name sortKey="Ghani, Khurshid R" sort="Ghani, Khurshid R" uniqKey="Ghani K" first="Khurshid R" last="Ghani">Khurshid R. Ghani</name>
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