Results of a cooperative educational program to improve prostate pathology reports among patients undergoing radical prostatectomy

The information contained in pathology reports of radical prostatectomy specimens is critically important to treating physicians for the selection of adjuvant therapy, the evaluation of therapy, estimating prognosis, and analyzing outcomes. This information is also important to patients and their families. The first phase of this study consisted of a retrospective chart review of 554 cases of radical prostatectomy (ICD-9-CM procedure code of 60.5) in New York State for the second six-month period of 1996. This review focused on ten elements (quality indicators): submission of a frozen section, location of the adenocarcinoma, proportion of specimen involved by adenocarcinoma, perineural involvement, vascular involvement, seminal vesicle status, periprostate fat status, number of nodes submitted, status of nodes, and PIN (prostate intra-epithelial neoplasia). The second phase of this project consisted of an educational feedback program involving the directors of pathology laboratories in all hospitals in New York State. A post-intervention review of the medical charts of all male Medicare patients discharged from New York State acute care hospitals with the ICD-9-CM procedure code of 60.5 (radical prostatectomy) was conducted for the six-month period February 1 through July 31, 1999. A total of 304 charts were reviewed. Performance on the ten indicators in the first phase of the study varied from 14.8% (periprostate fat status) to 85.9% (seminal vesicle involvement). Performance for all hospitals was 50% for four quality indicators and less than 70% for seven. Post-intervention improvements in performance occurred with nine of the ten quality indicators. These improvements ranged from 1.4% (status of lymph nodes submitted) to 23.9% (proportion of specimen involved by adenocarcinoma). The results of this study demonstrate that the issues identified in the baseline with radical prostatectomy pathology reports were amenable to a cooperative educational intervention.