Measuring quality of care


Quality of care can be assessed by assessing structures, processes and outcome of care.

The PCR collects the following clinical indicators to assess quality of care.


Quality dimension and indicators selected

Indicator type

Rationale for choosing the indicator

Safe, effective and patient-centred care

Percentage of men demonstrating treatment failure at 12 and 24 months post diagnosis  Outcome To identify men who do not appear to be responding to prostate cancer treatment regimens.
Patient assessment of physical health at 12 and 24 months post diagnosis  Outcome

To identify men who are demonstrating clinical signs of disability so that interventions may be considered to improve quality of life.

Patient assessment of mental health at 12 and 24 months post diagnosis  Outcome To identify men who are demonstrating clinical signs of disability so that interventions may be considered to improve quality of life.

Percent positive margins following prostatectomy

 Outcome

The presence of positive surgical margins following prostatectomy has been positively and independently associated with disease progression, even after accounting for stage of disease. Surgical experience and technique has been shown to impact on margin rates.4

Percentage of men with PSA level recorded post prostatectomy

Process

PSA levels for all men with prostate cancer who are having radical treatment should be checked at the earliest 6 weeks following treatment, at least every 6 months for the first 2 years, and at least once a year thereafter.1

Number of patients treated (by type of treatment) at each site 

Structure

There is evidence that quality of care is impacted on by number of patients treated.2

PSA level at 12 and 24 months post diagnosis

Outcome

Serum PSA level is a well regarded prognostic marker for progressive disease.3

Clear documentation of clinical TNM stage

Process

Documentation of clinical TNM provides evidence that a physical assessment has been undertaken in the assessment of patient risk and disease progression.2

Patient assessment of urinary, sexual and bowel functioning at 12 and 24 months post diagnosis for men who have undergone prostatectomy or radiation therapy

Outcome

Patient assessment of complications may assess underlying quality of care issues at clinician or institution level.2

Appropriate care

 

 

Percentage of men with advanced disease* who receive adjuvant hormonal therapy post radical radiotherapy 

Process

Adjuvant hormonal therapy is recommended for a minimum of 2 years in men receiving radical radiotherapy for localised prostate cancer who have a Gleason score of ≥ 8.1

Percentage of men with advanced disease* who were given brachytherapy

Process

Brachytherapy is NOT recommended for men with advanced prostate disease.1

Percentage of men with high risk disease† who were managed with active surveillance

Process

Active surveillance is NOT recommended for men with advanced prostate disease.1

Timeliness/ Equity/Access to care

Time from diagnosis (first biopsy) to initial treatment

Outcome

Delay in treatment may reflect organisational management or access to treatment.

Distance from place of residence to treatment

Outcome

Distance to treatment, in part, reflects access and equity of care. Treatment decisions may be impacted on by burden of access/travel. 


*advanced disease=  clinical stage T3-4, a Gleason score 8-10, a PSA density > 20 ng/ml/ml

†low risk disease=  clinical stage T1c, a Gleason score 3+3, a PSA density < 0.15 ng/ml/ml and who have cancer in less than 50% of their total number of biopsy cores with < 10mm of any core involved

        1.     National Collaborating Centre for Cancer.  Prostate Cancer: diagnosis and treatment. Full guideline. London: National Institute for Clinical Excellence (NICE), 2008; NICE clinical guideline 58.

        2.     Spencer B, Steinberg M, Malin J, et al.  Quality-of-care indicators for early-stage prostate cancer. J Clin Oncol.  2003; 21:1928-36.

        3.     Kumar P, Clarke M. Malignant disease. Kumar P, Clarke M. Clinical Medicine. 7th edition. Elsevier Limited, 2009.

        4.     Eastham JA, Kattan MW, Riedel E et al. Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. Journal of Urology 2003; 170(6 Pt 1):2292-5.