Administrative Memos

200002

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 10, 2000
SUBJECT: Improvements In Prostate Pathology Practices
IPRO CONTACTS:

Pascal James Imperato, M.D., M.P.H. & T.M. Medical Director, Research Development & Epidemiology Extension 532 and Terri A. Straub, R. N, M.B.A.. Senior Director, Improvement Strategies/Quality Improvement Extension 548

Enclosed please find a statewide report on "Improvements In Prostate Pathology Practices Among Medicare Patients Undergoing Radical Prostatectomy in New York State". This quality improvement project was initiated in response to concerns expressed about the adequacy of information contained in pathology reports on radical prostatectomy specimens.

During 1997, IPRO worked closely with its Radical Prostatectomy Pathology Advisory Group (RPPAG) to design a project to assess the quality of pathology reports on radical prostatectomy specimens for the period July 1 - December 31, 1996. The group suggested that the reports be examined for ten quality indicators relevant to patient care. A retrospective chart review was conducted in 1998 of the 554 Medicare patients who underwent radical prostatectomy during the later half of 1996.

Performance on the ten quality indicators varied from 15% to 86%. For all hospitals, performance was less than 50% for four quality indicators and less than 70% for seven. High volume hospitals (10 or more cases) performed significantly better than low volume ones (1-4 cases) with five indicators. Their performance was also better with an additional two indicators, but the differences were not statistically significant. These results demonstrated a significant relationship between higher volumes of prostate gland processing and better quality pathology reports.

The second phase of this project consisted of an educational feedback program involving the directors of pathology laboratories in all hospitals in New York State. The aggregate findings of the baseline study were shared with all pathologists. In addition, each hospital that performed radical prostatectomies received its own specific data so that it could compare its performance to the aggregate one. A second feature of the educational feedback consisted of telephone conferences conducted with the directors of hospital pathology laboratories, clinical pathologists, and others where most radical prostatectomies were performed. The purposes of these telephone conferences were to discuss the baseline findings, to encourage the adoption of standardized protocols and guidelines, and to assist hospitals in developing quality improvement programs. The participation in these conferences of hospitals that had successful systems in place for assuring the quality of their reports was extremely helpful in that they were able to share their experiences with those that were seeking to improve theirs.

A post-intervention review of the medical charts of all male Medicare patients discharged from New York State acute care hospitals with the ICD-9-CM procedure code of 60.5 (radical prostatectomy) was conducted for the six-month period February 1 through July 31, 1999. A total of 304 charts were reviewed.

Improvements in performance during 1999 occurred with nine of the ten quality indicators. These improvements ranged from 1.4% (status of lymph nodes submitted) to 23.9% (proportion of specimen involved by adenocarcinoma).

The results of this study demonstrate that the issues identified in the baseline with radical prostatectomy reports were amenable to a cooperative educational intervention. The adoption of standardized protocols advocated by pathology specialty groups can serve to replace traditional narrative descriptions, which are frequently incomplete. The use of these protocols not only provides conformity in radical prostatectomy specimen reports between institutions, but also for a comprehensiveness that can result in better quality of care for patients. IPRO will be happy to work with individual hospitals and provide additional information when needed.

Although this project is completed, IPRO has just begun a study of Breast Cancer Pathology Practices among Medicare patients. Thus, IPRO will continue to work closely with pathology departments in the area of quality improvement.

Should you have any questions about IPRO's Radical Prostatectomy Pathology Study or the recently initiated Breast Cancer Pathology Study, please feel free to call the above contacts.