Kaiser's prostate cancer care program reports improvements

A comprehensive, population-based regional healthcare management program for men with prostate cancer who are members of Kaiser Permanente Southern California has led to improved outcomes, according to a Kaiser Permanente study published in Urology Practice.

Kaiser Permanente Southern California developed the prostate cancer care program in 2003. It is focused on screening and prevention, shared decision making for treatment following diagnosis and care improvement for men with localized and advanced disease.

Related:Cancer management demands evidence-based treatment

“The program is designed to span the continuum of care and is primarily focused on screening and prevention, shared decision making for treatment following diagnosis and care improvement for men with localized and advanced disease,” says author Ronald K. Loo, MD, regional chief of urology, Southern California Permanente Medical Group. “We wanted to see if managing prostate cancer as a chronic condition would favorably impact patient satisfaction and clinical outcome. What we found was that the program resulted in improved quality and better outcomes for these prostate cancer patients.”

Specifically, the improvements made to the healthcare delivery model include:

• A 50% reduction of prostate cancer screening among men over the aged 75 years when the harms of screening are considered to outweigh the benefits.

• A new prostate cancer safety-net program identified a large number of patients who underwent a screening blood test for prostate cancer (PSA) who had unresolved follow up. More than 1,000 patients were ultimately diagnosed with prostate cancer who otherwise may have had a delay in diagnosis or otherwise been missed.

• Men who underwent a laparoscopic prostatectomy procedure assisted by new robotic technology had lower rates of blood loss and were more likely to report return of sexual function following the procedure. Continuous process improvement has made robotic surgery for prostate cancer safe, cost-effective, and with benchmark, reproducible outcomes.

“The program is designed to span the continuum of care and is primarily focused on screening and prevention, shared decision making for treatment following diagnosis and care improvement for men with localized and advanced disease,” says study author Ronald K. Loo, MD, regional chief of urology, Southern California Permanente Medical Group. “We wanted to see if managing prostate cancer as a chronic condition would favorably impact patient satisfaction and clinical outcome. What we found was that the program resulted in improved quality and better outcomes for these prostate cancer patients.

NEXT: "Providing safe, reliable, cost-effective and evidence-based care to all members afflicted with prostate cancer.."

LooIn addition, before Dr. Loo and colleagues began their work, many patients were receiving expensive chemotherapy medications with unreliable oversight. Medications utilization was unknown.

“Outcome from medication dispensing was unknown, and side effects and complications from these medications was never properly addressed,” Dr. Loo says. “As the result of our work, survival has improved, side effects have diminished, costs have significantly reduced, and iatrogenic complications are significantly improved.”

As an example, because a particular chemotherapy [leuprolide] is known to worsen bone demineralization, according to Dr. Loo, standardized intense screening and treatment for osteoporosis in this population has resulted in a >70% reduction in hip fractures, “saving needless suffering and countless lives. Medication mismanagement is one of the most costly and wasteful processes that requires careful control,” he says.

“We are focused on providing safe, reliable, cost-effective and evidence-based care to all members afflicted with prostate cancer, irrespective of where they live, or with whom they seek their care,” Dr. Loo continues. “To do so across a relatively wide geographic region, developing evidence-based recommendations and protocols for management is only part of the solution.”

Leveraging its integrated healthcare delivery model by hard-wiring these recommendations and protocols is where Kaiser has achieved most of our recent success, according to Dr. Loo.

Related:HHS awards $110 million for delivery system reform

“Because our entire healthcare delivery team actively participates in analyzing external and internal evidence, and helps formulate our protocols for management, we achieve remarkable compliance because everyone owns the model,” he says. “We have realized millions of dollars in cost savings as a by-product of this quality improvement work, not as a primary goal.”

The program that was put in place in 2003 initially as a case management program to manage advanced cancer patients who received clinic administered chemotherapy.  As additional subpopulations within the prostate cancer umbrella were identified, the program expanded to improve the spectrum of care related to prostate cancer addressed screening, shared decision-making for treatment following diagnosis and care improvement for men with localized disease who elect to undergo robotic surgery. 

“These were implemented with traditional quality improvement techniques and outcomes were evaluated in collaboration with research groups embedded within the organization,” Dr. Loo says. “We now cover almost the entire spectrum of prostate cancer management and have transferred this process to other conditions and applications.”

Dr. Loo believes that other healthcare providers and organizations may wish to adopt aspects of this program, as clinicians treating men with prostate cancer aim to provide the highest quality, affordable care.

Related:WellPoint initiative aims to identify cancer treatment therapies

“A fully integrated healthcare delivery model is not mandatory to adopt many of our successful processes, but it does require close collaboration and interdependence,” he says.

“Encourage your clinical care delivery teams to look for ways to deliver reliable, reproducible, evidence-based care,” Dr. Loo advises. “Furthermore, the stakeholders who deliver this care must own the process, otherwise they will never be fully invested or accountable.  Improve the reliability and quality first, and the cost savings will follow accordingly.”