Urological Surgical Improvement Through Patient Engagement

    Urology practices provide the majority of prostate cancer-related services, so they represent a logical focal point for efforts aimed at improving the value of prostate cancer care.

    Historically the ability for urologists to improve care has been limited by two significant concerns. First, most urologists have little or no access to data regarding the quality of care provided in their own practice. Second, even when such “quality data” is available, few understand how to use the data to change their practice in order to achieve measurable improvements.

    The Michigan Urological Surgery Improvement Collaborative (MUSIC) has spent nearly a decade changing all of this.

     

    Collaborative Learning at MUSIC

    MUSIC is a physician-led quality improvement collaborative comprised of a consortium of urology practices in the state of Michigan. Since 2011, the collaborative has brought urologists together to evaluate and improve the quality and cost efficiency of prostate cancer care for men across the state.

     

    MUSIC’s specific goals include:

    • Evaluating and improving patterns of care in the radiographic staging of men with newly diagnosed prostate cancer

    • Reducing biopsy-related infectious hospitalizations

    • Optimizing treatment appropriateness for newly diagnosed prostate cancer patients with favorable risk disease

    • Enhancing patient-centered decision making among men considering local therapy

    • Improving outcomes after radical prostatectomy (prostate surgery) 

    When it started, MUSIC was the only physician-led urology quality improvement initiative in the U.S. Today, 90 percent of urologists in Michigan participate.

     

    Using Data to Drive to Quality Improvement Initiatives

    Collaboration, transparency, and data are the core of MUSIC. They use a secure, web‐based, clinical data registry to identify opportunities to improve processes of care, develop strategies for quality improvement (QI), and monitor the success of the implementation of QI interventions.

    The flexibility of MUSIC’s data infrastructure and registry has enabled the collaborative to expand its focus to cover a variety of urological diseases and procedures. Here are a few examples of recent initiatives:
    • In 2016, MUSIC launched MUSIC ROCKS, a program focused on reducing operative complications following kidney stone surgery. Having now expanded to include 40 participating sites and more than 180 urologists, the program has collected data on more than 20,000 patients who have undergone a kidney stone surgery. The program has already identified specific opportunities for quality improvement, including reducing avoidable emergency visits after these procedures and decreasing cost of care.
    • MUSIC runs a few registry-based randomized clinical trials to advance its research mission. G-MINOR evaluates the impact of a genomic biomarker on adjuvant treatment decisions among patients with high risk prostate cancer. G-MAJOR — supported by the National Institutes of Health — aims to understand the clinical utility of genomic classifiers in newly diagnosed favorable-risk prostate cancer patients. 

     

    Including the Patient Perspective with Patient-Reported Outcomes

    MUSIC also has a solid patient engagement and patient-reported outcomes program. The registry collects and analyzes patient-reported outcomes (PROs) to assess health-related quality of life and functional status before and after radical prostatectomy. Patient-reported outcomes provide researchers access to otherwise unavailable data, such as symptom status and quality of life that are crucial to improving patient health. The platform allows patients to interact directly with the registry via a PRO Patient Trend Report, which helps the patient and provider better plan for the patient’s recovery pathway following surgery.

    MUSIC-PRO’s streamlined, web-based format has yielded impressive levels of patient engagement, despite the sensitive subject matter of some patient surveys.

     

    Featured Results:

    MUSIC was the winner of the inaugural Clinical Innovator Technology Accelerator Award and was awarded the Blue Cross Blue Shield Association Best of Blue award for clinical distinction. Some of its award-winning results include:

    • 50 percent reduction in prostate biopsy-related hospitalizations
    • Decreased adverse events associated with prostate-cancer related procedures
    • State-wide reductions in the utilization of radiographic imaging for staging patients with low-risk prostate cancer reductions in the frequency of biopsy-related infectious complications
    • Laid the groundwork for using video review as a quality improvement strategy for assessing surgeons’ technical skill and identifying a potential correlation between case volumes and certain surgical outcomes.
    • Impressive levels of patient engagement, with the MUSIC-PRO survey completion rate at “88%, 84%, and 90% preoperatively, at 3 months, and 6 months. Electronic completion rates preoperatively, at 3 months, and 6 months were 70%, 70%, and 68%, respectively.” The same study concluded that “Collection of electronic PRO via this unified, web-based format was successful and provided results that reflect expected recovery and identify opportunities for improvement.” (Lucas et al., 2017).
    • Publishing numerous peer-reviewed manuscripts and abstracts in such publications as the Journal of Urology. 

     

    Featured Research:

    1. Regular vs. Selective Use of Closed Suction Drains Following Robot-Assisted Radical Prostatectomy: Results From a Regional Quality Improvement Collaborative.

    2. Validity of the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction Measures in Men Following Radical Prostatectomy.

    3. A Statewide Intervention Improves Appropriate Imaging in Localized Prostate Cancer.

     

    References:

    1. MUSIC Website. Accessed July 2020. https://musicurology.com/

    2. Blue Cross Blue Shield Website. Accessed July 2020. https://www.bcbsm.com/providers/value-partnerships/physician-group-incentive-prog/specialists/opportunities/michigan-urological-surgery-improvement-collaborative.html

    Learn more about MUSIC at musicurology.com.

    MUSIC logo main

    About the Michigan Urological Surgery Improvement Collaborative

    The Michigan Urological Surgery Improvement Collaborative is a physician-led collaborative that strives to improve outcomes for men with urological conditions across the state of Michigan. 

    Organization Type

    Quality Improvement Initiative

    ArborMetrix Solution Launch

    2013

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