Factors Associated with the Adoption of Minimally Invasive Radical Prostatectomy in the United States

Ulmer, William D.; Prasad, Sandip M.; Kowalczyk, Keith; Gu, Xiangmei; Dodgion, Christopher; Lipsitz, Stuart R.; Palapattu, Ganesh S.; Choueiri, Toni K.; Hu, Jim C.

doi:10.1016/j.juro.2012.05.014

Cited by 21 publications

(14 citation statements)

References 29 publications

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“…It is possible that larger hospitals are more likely to have the resources needed to invest in new technologies. Hospital volume has been shown in past studies to be associated with newer surgical techniques in breast cancer 48–50 as well as prostate 51 and rectal 52 cancers.…”

Section: Discussionmentioning

confidence: 99%

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery

Sen

Soulos

Herrin

et al. 2014

Surgery

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BACKGROUND Little is known about the relation between surgical care for breast cancer at for-profit hospitals and subsequent use of adjuvant radiation therapy (RT). Among Medicare beneficiaries, we examined whether hospital ownership status is associated with the use of breast brachytherapy – a newer and more expensive modality – as well as overall RT. METHODS We conducted a retrospective study of female Medicare beneficiaries receiving breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy or overall RT using hierarchical generalized linear models. RESULTS The sample consisted of 35,118 women, 8.0% of whom had surgery at for-profit hospitals. Among patients who received RT, those who underwent surgery at for-profit hospitals were significantly more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; OR for for-profit vs. not-for-profit: 1.50; 95%CI: 1.23–1.84; p<0.001). Among women aged 66–79, there was no relation between hospital ownership status and overall RT use. Among women aged 80–94 years old – the group least likely to benefit from RT due to shorter life expectancy – receipt of surgery at a for-profit hospital was significantly associated with higher overall RT use (OR: 1.22; 95%CI: 1.03–1.45, p=0.03) and brachytherapy use (OR: 1.66; 95%CI: 1.18–2.34, p=0.003). CONCLUSIONS Surgical care at for-profit hospitals was associated with increased use of the newer and more expensive RT modality, brachytherapy. Among the oldest women, who are least likely to benefit from RT, surgical care at a for-profit hospital was associated with higher overall RT use, with this difference largely driven by the use of brachytherapy.

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Section: Discussionmentioning

confidence: 99%

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery

Sen

Soulos

Herrin

et al. 2014

Surgery

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“…18 Third, markets with high managed care penetration are typified by higher socioeconomic class, which is strongly associated with the adoption of new technology, including robotic prostatectomy. 19,20 …”

Section: Discussionmentioning

confidence: 99%

Managed Care and the Dissemination of Robotic Prostatectomy

et al. 2014

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Objective Robotic prostatectomy has rapidly disseminated over the past decade. How managed care, thought by many to be a barrier to new technology, influences the dissemination of robotics is unknown. We sought to better understand the relationship between a market’s managed care penetration and the dissemination of robotic prostatectomy. Methods We used SEER-Medicare data from 2003 through 2007 to identify men ≥ 66 years of age treated with radical prostatectomy for prostate cancer. We categorized Health Service Areas (HSAs) according to the degree of managed care penetration (i.e., low vs. high). We assessed adoption of robotic prostatectomy and utilization among adopting HSAs using Cox proportional-hazards and Poisson regression models, respectively. Results Compared with markets with little managed care, highly penetrated markets had more racial diversity (24% vs. 15% non-white, p<0.01), higher population densities (1987 vs. 422 people/square mile, p<0.01), and higher median incomes ($49,374 vs. $36,236, p<0.01). Robotic prostatectomy adoption and utilization increased over time in both HSA categories. Compared with low managed care markets, those with high managed care adopted robotic prostatectomy more rapidly (e.g., probability 0.37 [low] vs. 0.52 [high] in 2007; p<0.01). However, the post-adoption utilization of robotic prostatectomy was constrained in these highly penetrated markets (e.g., probability 0.66 [low] vs. 0.52 [high] in 2007; p<0.01). Conclusions High managed care penetration was associated with more rapid robotic prostatectomy adoption. However, once adopted, utilization increased more slowly in these markets. Understanding this paradox is important, as more technologies are unveiled in an increasing cost-conscious healthcare environment.

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“…Any characteristics with P < 0.20 were included in the final analysis along with hospital bed number which is a covariate known to affect both surgical robot adoption 35 and the utilization of partial nephrectomy at the hospital level. 36 …”

Section: Methodsmentioning

confidence: 99%

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

et al. 2015

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Introduction The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy. Methods We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors. Results In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy. Conclusions Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care.

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Factors Associated with the Adoption of Minimally Invasive Radical Prostatectomy in the United States

Cited by 21 publications

References 29 publications

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery

Managed Care and the Dissemination of Robotic Prostatectomy

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

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