Most would agree that a key to improving health care quality is learning from data of the past. In the case of prostate cancer care, this used to be difficult. Though some urologists would keep personal notes of surgical successes and complications, there were no accepted standards of collecting or reporting data, making it difficult to compare experiences. Without data, how can we identify best practices and opportunities for improvement? How can we reduce unnecessary costs and improve the quality of care for patients with prostate cancer? In January 2012, Blue Cross Blue Shield of Michigan and 21 doctor offices throughout the state launched a new initiative to fill this need: The Michigan Urological Surgery Improvement Collaborative (MUSIC). Fast forward several years and MUSIC has been nationally recognized with the 2014 Accelerator Award by Clinical Innovation + Technology for succeeding in improving care coordination, streamlining clinicians’ workflow and using data to address various issues. How did we get here, and what impact has MUSIC had on Michigan over the past few years? We asked Amy Jarabek, senior analyst of Value Partnerships Programs at BCBSM.
Q: What is the Michigan Urological Surgery Improvement Collaborative? What’s the goal?
A: The goal of the MUSIC is to make Michigan the best place in the world to receive prostate cancer care. For men who have a low-risk prostate cancer, where the cancer is slow-growing, self-contained and not in danger of spreading to or damaging other organs, MUSIC aims to reduce unnecessary testing. Not only is testing expensive, but it can also expose men to radiation. In men with high-risk cancers, where the cancer is fast growing and spreading to other organs, MUSIC aims to determine the best therapies and treatments, reduce complications from biopsy, and improve outcomes after prostatectomy.
Q: How does MUSIC work? And how does it impact patients with prostate cancer?
A: Urologists across Michigan compare data and share observations on various cancer therapies and treatments, allowing them to identify and share best practices associated with improved patient outcomes. Based on this information, physicians also are developing guidelines to reduce variation in practice patterns. Higher variations in care patterns are associated with lower quality and higher costs.
Q: Now that we’re a few years into this initiative, do you see it making a difference?
A: There is no doubt that MUSIC has improved care for patients and their communities. One of the initial efforts was focused on improving patterns of care in the staging of men with newly diagnosed cancer. Sometimes using bone and CT scans to determine what stage of cancer the patient is in is complicated an over costly. By using clearly defined evidence to guide staging bone and CT scans, we’ve seen a statewide decrease in the use of both. The initiative also has developed two processes for reducing the number of serious infectious complications that result in hospital admissions after prostate biopsies.
Q: Why do you think MUSIC has been able to make such an impact?
A: One of the reasons MUSIC is so impactful is because it brings together evidence-based medicine, clinical experience and collaborative physician learning. At the heart of MUSIC is a web-based clinical registry where participating practices submit data on patients undergoing a prostate biopsy, as well as patients newly diagnosed with prostate cancer. This then provides urologists throughout Michigan with near real-time feedback on patient characteristics, diagnostic practices and treatment outcomes. To take it one step further, MUSIC hosts tri-annual collaborative-wide meetings that allow urologists to discuss the data in more detail, provide and receive performance feedback, and implement specific strategies for improving patient care. In just a few years, MUSIC has enrolled more than 40 oncology practices, representing 225 urologists across Michigan. Since the inception of the program in January 2012, MUSIC has collected the data of more than 10,000 patients. This year, patients with prostate cancer were brought into the collaborative, including them in workgroups and meetings to gain their perspective.
Q: What are the next steps for the program?
A: MUSIC continues to make meaningful progress towards its ultimate goal of making Michigan the best place in the world to receive prostate cancer care. More and more physician practices are participating in the initiative. The goal is to further reduce complications, assess repeat problems and improve patient outcomes. In the next few months, MUSIC’s Coordinating Center will embark on the second phase of MUSIC-Patient Reported Outcomes. This will involve the integration of patient outcome reports into routine clinic visits, as well as the participation of additional practices in the collection of patient data. MUSIC will also continue its pursuit of reviewing videotaped surgeries to look at surgeons’ skill level as the surgery is performed. By comparing the videos with reports on patients’ outcomes, urologists can link certain skills to better outcomes. The Michigan Urological Surgery Improvement Collaborative is one of the programs under Value Partnerships, a series of initiatives among physicians, hospitals and the Michigan Blues, aimed at improving quality and safety in medical care. Photo Credit: Military Health