Achieving Benchmarks for National Quality Indicators Reduces Recurrence and Progression in Non-muscle-invasive...

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Noncompliance with evidence-based guidelines for non-muscle-invasive bladder cancer (NMIBC) leads to variable patient outcomes.
• Scotland's National Health Service (NHS) implemented a Quality Performance Indicator (QPI) program to standardize care and improve cancer outcomes.

Purpose of the Study:

• To evaluate the impact of achieving specific QPI benchmarks on recurrence and progression rates in NMIBC patients.
• To assess the real-world effectiveness of quality improvement initiatives in bladder cancer management.

Main Methods:

• Prospective data collection from 12 NHS centers on new bladder cancer patients from April 2014 to March 2017.
• Analysis focused on two QPIs: detrusor muscle (DM) sampling during transurethral resection of bladder tumor (TURBT) and single instillation of mitomycin C (SI-MMC) post-TURBT.
• Kaplan-Meier and Cox regression analyses were used to determine time to recurrence and progression.

Main Results:

• Hospitals meeting the DM sampling target showed a 5.4% lower 5-year recurrence rate (38.9% vs. 44.3%).
• Use of SI-MMC was associated with a 20.4% lower recurrence rate (35.4% vs. 55.8%).
• Both QPI adherence and SI-MMC use significantly improved recurrence-free and progression-free survival on multivariable analysis.

Conclusions:

• Adherence to QPI targets for DM sampling and SI-MMC use in NMIBC care is independently associated with delayed recurrence and progression.
• The national QPI program demonstrated real-world effectiveness in improving outcomes for bladder cancer patients.
• These findings support the continued implementation and monitoring of QPIs in NMIBC management.