Larger PSA screening decline observed with patients in ACOs

Emilie K. Johnson, MD, MPHA comparison of four methods for evaluating microhematuria and an evaluation of a value-based care pathway for men undergoing surgery for BPH were among other noteworthy AUA 2017 studies in the area of outcomes. The take-home messages were presented by Emilie K. Johnson, MD, MPH, of Northwestern University, Chicago.

An analysis of the prevalence and appropriateness of prostate cancer screening practices showed that screening rates declined across the entire study population, that larger declines occurred among men enrolled in accountable care organizations (ACOs), and that the highest screening rates occurred in men who had the highest estimated 5-year survival-raising questions about the balance between financial incentives and patient-centered clinical practice.

Men with ≥75% 10-year risk of noncancer mortality had a statistically significant 11% decrease in the likelihood of potential overtreatment of prostate cancer if enrolled in an ACO.

Development and use of a natural language processing (NLP) system to extract key information from bladder cancer pathology reports in an electronic medical record showed the NLP system could accurately extract data on grade and presence/absence of invasion for use in longitudinal analyses without an accompanying manual review.

A comparison of four methods for evaluating microhematuria showed that the combination of ultrasound and cystoscopy was most effective and that use of computed tomography instead of ultrasound added $65 million to the total cost of evaluation but detected only one additional cancer.

A comparison of 30- and 90-day costs of radical cystectomy showed that minimally invasive procedures were associated with higher costs during initial hospitalization as compared with open procedures, but follow-up hospital costs and readmission rates were similar.

An evaluation of a value-based care pathway for men undergoing surgery for BPH showed that outcomes were no worse among men who received treatment from surgeons who provided usual care and that providing urologists feedback on outcomes, costs, and practice patterns had only a modest impact in terms of driving providers toward the care path.

A study comparing Centers for Medicare & Medicaid Services Hospital Compare Star Rankings and short-term outcomes after major urologic cancer surgery showed that patients treated at higher ranking hospitals had lower 30-day readmission rates and mortality.

A study involving 195 California urologists showed that those who posted surgical videos on YouTube had higher consumer ratings and that those who had active YouTube and Twitter accounts had higher prostatectomy volumes but not higher transurethral resection of the prostate volumes; postings on Instagram and Facebook did not influence ratings or surgical volumes.

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