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Technology diffusion and prostate cancer quality of care.
Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Zhang Y, Hollenbeck BK. Technology diffusion and prostate cancer quality of care. Urology. 2014 Nov 1; 84(5):1066-72.
To evaluate the association of technological capacity with prostate cancer quality of care. Technological capacity was conceptualized as a market''s ability to provide prostate cancer treatment with new technology, including robotic prostatectomy and intensity-modulated radiotherapy (IMRT).
In this retrospective cohort study, we used data from the Surveillance, Epidemiology, and End Results-Medicare linked database from 2004 to 2009 to identify men with newly diagnosed prostate cancer (n = 46,274). We measured technological capacity as the number of providers performing robotic prostatectomy or IMRT per population in a health care market. We used multilevel logistic regression analysis to assess the association of technological capacity with receiving quality care according to a set of nationally endorsed quality measures, while adjusting for patient and market characteristics.
Overall, our findings were mixed with only subtle differences in quality of care comparing high-tech with low-tech markets. High robotic prostatectomy capacity was associated with better adherence to some quality measures, such as avoiding unnecessary bone scans (79.8% vs 73.0%; P = .003) and having follow-up with urologists (67.7% vs 62.6%; P = .023). However, for most measures, neither high robotic prostatectomy nor high-IMRT capacity was associated with significant increases in adherence rates. In fact, for 1 measure (treatment by a high-volume provider), high-IMRT capacity was associated with lower performance (23.4% vs 28.5%; P < .001).
Our findings suggest that new technology is not clearly associated with higher quality of care. To improve quality, more specific efforts will be needed.