Lba3 the Changing Face of Urologic Oncologic Surgery From 2000-2018 (63 141 Patients) - Impact of Robotics

Abstract

INTRODUCTION AND OBJECTIVES: 21 years ago the Institute of Medicine articulated a vision of a learning healthcare system based on electronic health records (EHRs). Building on federal investment in EHRs and policy reform linking payment to quality, the American Urological Association invested in a platform to aggregate clinical data from EHRs for quality measurement and reporting. The resulting AQUA Registry is a Qualified Clinical Data Repository (QCDR) that can report quality measures to the Centers for Medicare and Medicaid Services (CMS). We describe AQUA participants and report early trends in quality scores reported to CMS through AQUA.METHODS: This is a retrospective analysis of AQUA participation from 2014-2016. We compared characteristics of urologists and practices participating in AQUA to those of the broader urologist population as reported in the 2016 AUA Census. We assessed the impact of AQUA participation on quality of care by comparing measure pass rates pre and post participation. To ensure data validity we limited our analysis to measures reported to CMS, with a denominator 10, and from practices with 180 days of participation. To evaluate the trend before and after joining AQUA, we fit a univariate linear spline regression with a knot at time 0.RESULTS: Participation in AQUA increased rapidly during the first full 3 years of operation and now includes over 125 practices and 1148 urologists (9.4%). 97.6% of AQUA participants are in private practice, 1.9% are in academic practice, and 0.5% are employed by private or public hospitals, compared with 59.1%, 25.5% and 11.2% respectively among urologists nationally. 95.9% of AQUA participants live in metropolitan areas compared with 89.9% of urologists nationally, and they are 4 years younger. Participation is distributed across regions and states. 17 quality measures were reported to CMS through AQUA, 4 of which were urology specific and 13 of which were cross-cutting measures. Figure 1 shows the mean pass rate on each of the 4 urologic measures before and after participation in AQUA.CONCLUSIONS: Early participants in the AQUA registry were mostly community practitioners in metropolitan areas. 3 of 4 urologic measures examined showed improvement and 1 showed no change, suggesting that measuring care facilitated gains in measurement and possibly quality.

Impact of Surgical Approach on Patient-Reported Outcomes after Radical Prostatectomy: A Propensity Score-Weighted Analysis from a Multicenter, Prospective, Observational Study (The Pros-IT CNR Study)

“…When considering specific questions, that is, the number of pad at 12 months and erection stiff for intercourse at 12 months, absolute rates were fairly inferior with respect to previous reports [3][4][5]. However, these [3][4][5] generally involved only one or few experienced surgeons, at high-volume institutions.…”

“…However, these [3][4][5] generally involved only one or few experienced surgeons, at high-volume institutions. Additionally, the definition of both continence and potency were often arbitrary and lack of standardized definition.…”

“…Comprehensive meta-analyses [3][4][5] of retrospective institutional series, as well as the only available randomized controlled trail [6,7], did not provide definitive data on the superiority of one surgical approach over the others. On the whole, these studies have been criticized because of arbitrary outcome definitions, lack of validated outcome measures, short follow-up time, disparities in surgeon's experience and inclusion of series from single surgeons or high volume institutions [8].…”

Consulting ‘Dr. Google’ for minimally invasive urological oncological surgeries: A contemporary web‐based trend analysis

“…Minimally invasive surgery (MIS) is a rapidly increasing surgical modality across a wide spectrum of surgical disciplines 1 . Since the first laparoscopic appendectomy in 1983, 2 surgeons have adopted MIS techniques for a wide variety of applications leading to its most recent technological iteration: robotic surgical systems 3 . Although an impressive amount of studies have been published on the impact of MIS within the healthcare space, the entire pool of findings is based on clinical trials or national databases.…”

Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot‐assisted radical prostatectomy

“…The management of localised intermediate‐ and high‐risk disease has largely been with radical prostatectomy (RP) . Improved visualisation and instrument manoeuvrability have made robot‐assisted RP (RARP) a widely accepted approach, such that 85% of all RPs are RARPs . However, due to the location of the prostate deep within the pelvic cavity, RARP can be challenged by bony pelvic anatomy.…”