Real-life benchmarking bladder cancer care: A population-based study.

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Radical cystectomy (RC) is a complex procedure for bladder cancer.
• Population studies indicate variable outcomes, often suboptimal compared to high-volume centers.
• Previous consensus established quality-of-care indicators and benchmarks for bladder cancer management.

Purpose of the Study:

• To report real-world performance on key quality-of-care indicators for muscle-invasive bladder cancer (MIBC) management in Ontario.
• To compare actual practice against expert-defined benchmarks.
• To evaluate different benchmarking methodologies.

Main Methods:

• Population-based retrospective cohort study using the Ontario Cancer Registry (2009-2013).
• Included 1573 patients who underwent radical cystectomy.
• Analyzed treatment records and pathology data, comparing outcomes to established benchmarks and using a 'pared-mean' approach for top performers.

Main Results:

• Overall performance across most quality indicators fell short of expert benchmarks.
• Key areas of underperformance included surgeon volume, preoperative referrals to medical and radiation oncology, time to cystectomy, lymph node dissection adequacy, and 90-day mortality.
• A significant proportion of institutions (46%) met the benchmark for positive surgical margins, and 37% met the 90-day mortality benchmark.

Conclusions:

• Current quality-of-care indicator performance for MIBC management in Ontario is below expert-defined benchmarks.
• Median performance may underestimate achievable outcomes.
• A 'pared-mean' approach focusing on top performers may offer a more realistic and aspirational benchmarking strategy.