Measuring Quality of Care
Quality of care can be determined by assessing structures, processes and outcomes of care.
The IPCOR study will collect data and report on the following clinical indicators to assess quality of care.
Quality indicators table
|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 time points 12, 24, 36, 48 and 60 months||Outcome||It is important to identify those men who do not appear to be responding to prostate cancer treatment regimens.|
|Patient assessment of physical health at 12, 24, 36, 48 and 60 months post diagnosis||Outcome||It is important 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, 24, 36, 48 and 60 months post diagnosis||Outcome||It is important 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 for T2 and T3 disease||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.|
|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 then at least once a year thereafter.|
|Volume (number) of patients treated (by type of treatment – surgery, radiotx, surveillance) at each site||Structure||There is evidence that quality of care is impacted on by volume of patients treated.|
|PSA level at 12, 24, 36, 48 and 60 months||Outcome||Serum prostate-specific antigen (PSA) level is a well regarded prognostic marker for progressive disease.|
|Percentage of men with 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.|
|Percentage of men who complete patient assessment of urinary, sexual and bowel functioning at 12, 24, 36, 48 and 60 months post diagnosis for men who have undergone prostatectomy or radiation therapy or surveillance(PROM data)||Outcome||Patient assessment of complications may assess underlying quality of care issues at clinician or institution level.|
|Percentage of men with low, intermediate or high grade disease who receive adjuvant hormonal therapy post radical radiotherapy (d’Amico)||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.|
|Percentage of men with low, intermediate or high grade disease who were given brachytherapy (d’Amico)||Process||Brachytherapy is NOT recommended for men with advanced prostate disease.|
|Percentage of men with low, intermediate or high grade disease who were managed with active surveillance (d’Amico)||Process||Active surveillance is NOT recommended for men with advanced prostate disease.|
|Percentage of men over 75 years of age who received treatment for their prostate cancer||Process||Older men may be undertreated for prostate cancer|
|Timeliness/ Equity/Access to care|
|Time from diagnosis (diagnostic biopsy) to initial treatment||Outcome||Delay in treatment may reflect organisational management or access to treatment.|
|Distance from place of residence to treatment centre||Outcome||Distance to treatment, in part, reflects access and equity of care. Treatment decisions may be impacted on by burden of access/travel.|
|Time form GP referral to biopsy||Access||Delay in assessment may reflect organisational management or access to care.|
|Time from diagnosis to MRI scan||Resources||Access to MRI imaging in prostate cancer diagnosis, staging and decision making is vital.|
|Numbers undergoing each treatment at each Treatment centre||Access||Patients should be allowed access to the full range of treatments in each centre|
The Irish Prostate Cancer Outcomes Research is establishing a nationwide prostate cancer registry which captures high-quality information from newly diagnosed prostate cancer patients in the Republic of Ireland.
Our main objective is to collect detailed clinical and quality of life data on Irish men’s prostate cancer journey to better inform future care delivery, knowledge of the disease and best use of health care innovations and resources.