The Continuum of Prostate Cancer Care: An Integrated Population Based Model of Health Care Delivery

Abstract Introduction We present a comprehensive model for population based prostate cancer management that is scalable, and has improved quality and outcomes. Methods Kaiser Permanente Southern California is an integrated health care system that provides comprehensive care for 3.7 million members. Beginning in 2003 we put programs into place to improve the spectrum of care related to prostate cancer. These programs addressed screening, shared decision making for treatment after diagnosis, and care improvement for men with localized and advanced disease. These were implemented with traditional quality improvement techniques and outcomes were evaluated in collaboration with research groups embedded in the organization. Results Prostate cancer screening in men 75 years old or older decreased 50% from 30% to 15%. The Safety Net program identified nearly 1,200 men with prostate cancer who had not been seen for followup from 2006 to 2010. There was a reduction in blood loss in surgical procedures that obviated the need for transfusion while maintaining a low positive margin rate. Hormonal therapy was changed to a dosing approach that was based on circulating testosterone levels, preventing some of the side effects of this therapy. Coupled with a systems approach to osteoporosis prevention, this approach resulted in a dramatic reduction in fracture rates in this high risk population. Conclusions These data demonstrate that a systems approach to a population based prostate cancer program can lead to efficient and reliable care that can be successfully disseminated through an integrated health plan.