Empowering Patients in Their Cancer Treatment: Michigan’s MUSIC Collaborative
The Michigan Urological Surgery Improvement Collaborative (MUSIC) is one of Blue Cross Blue Shield of Michigan’s collaborative quality initiatives, focused on making Michigan the best in the U.S. for urologic care. Over 250 Michigan urologists, representing 90% of the urologists in the state, participate in this initiative.
Part of the journey to become the best in urologic care includes involving patients as part of their own care team and helping them to feel empowered in their treatment. The MUSIC collaborative quality initiative has uncovered three main ways to put patients in the driver’ seats of their care and help providers better understand the needs of patients and outcomes associated with different treatment methods.
As men age into their 70’s and beyond, many will start developing prostate cancer which is typically a very slow growing cancer that doesn’t present near-term challenges for the patient. In most cases, it is not the ultimate cause of death. The risks associated with treating prostate cancer — urinary incontinence, erectile dysfunction, among others — far outweigh the benefits for many men considering prostate cancer treatment. That is where active surveillance comes into play.
Active surveillance is a method of forgoing surgery or radiation, and instead, regularly monitoring the cancer to determine when, and if, a patient needs more invasive treatment.
For prostate cancer patients with favorable-risk or early stage disease, active surveillance should be considered as a management option. To provide guidance on the administration of active surveillance for management of men with lower risk prostate cancer, MUSIC developed a roadmap as well as several patient educational resources. For patients who are on active surveillance, appropriate follow-up care is critically important.
Personal Patient Profile-Prostate tool
To further optimize patient-centered decision making among men considering a course of treatment for early-state prostate cancer, MUSIC also offers the Personal Patient Profile-Prostate (P3P) tool. P3P is a questionnaire that patients complete following their diagnosis, but before having a treatment discussion with their doctor. Patients’ responses to these questions help to ensure that the selected treatment aligns with patients’ preferences, values and goals.
MUSIC is actively working to integrate P3P as a standard of patient care with about 25% of MUSIC practices and affiliated urologists currently offering it to their patients. For patients who have used the tool, 73% recently reported feeling more informed about the risks, benefits and limitations of the different treatment options available to them. More than 90% said it helped them to consider specific questions and/or concerns to discuss with their doctor.
This collective patient-centered approach relies on patient education and empowerment. As a result of the collaborative’s efforts, MUSIC saw a significant, statewide increase in low-risk patients continuing active surveillance with 57% in 2015 and 83% in 2019.
Increasingly across Michigan, active surveillance is being seen as an accepted treatment option for low-risk patients in the same way that surgery and radiation were previously accepted as the only standard treatments for prostate cancer.
Patient reported outcomes
One of MUSIC’s key priorities focuses on improving patient outcomes after prostate surgery. To achieve this goal, MUSIC developed MUSIC PROs, or patient-reported outcomes, a statewide electronic infrastructure for measuring and improving functional outcomes after prostate surgery.
Men with prostate cancer who are scheduled to have prostate surgery are asked to complete the questionnaire before surgery and at five different points in the two years following. The results of the questionnaire are delivered to physicians through the registry via a report displaying patient responses as well as trends in the patient’s recovery of function over time. This patient level information aids in optimizing a patient’s recovery after surgery.
Dr. William K. Johnston III, a urologist with the Michigan Institute of Urology and active MUSIC member, commented on the importance of MUSIC PRO noting, “As surgeons, we endlessly pursue the perfect technique, but knowing how it impacts outcomes requires knowing the data. The data available through MUSIC PRO is such a vital part of improving outcomes.”
To learn more about the MUSIC collaborative quality initiative, please visit musicurology.com.
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