No AccessUrology PracticePatient Care1 Mar 2015

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

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    We present a comprehensive model for population based prostate cancer management that is scalable, and has improved quality and outcomes.


    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.


    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.


    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.


    • 1 : Cancer Facts & Figures 2014. Atlanta: American Cancer Society2014. Google Scholar
    • 2 DeVol R, Bedroussian A, Charuworn A et al: An Unhealthy America: The Economic Burden of Chronic Disease – Charting a New Course to Save Lives and Increase Productivity and Economic Growth. Available at Google Scholar
    • 3 : Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. Perm J2012; 16: 37. Google Scholar
    • 4 : Complete care at Kaiser Permanente: transforming chronic and preventive care. Jt Comm J Qual Patient Saf2013; 39: 484. Google Scholar
    • 5 : Proactive office encounter: a systematic approach to preventive and chronic care at every patient encounter. Perm J2010; 14: 38. Google Scholar
    • 6 : Systemic implementation strategies to improve hypertension: The Kaiser Permanente Southern California experience. Can J Cardiol2014; 30: 544. Google Scholar
    • 7 : Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med2008; 149: 185. Google Scholar
    • 8 : Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA1993; 270: 860. Google Scholar
    • 9 : Development and validation of the Expanded Prostate Cancer Index Composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology2000; 56: 899. Google Scholar
    • 10 : Rapid implementation of a robot-assisted prostatectomy program in a large health maintenance organization setting. J Endourol2010; 24: 461. Google Scholar
    • 11 : Failure modes and effects analysis in clinical engineering. J Clin Eng1992; 17: 59. Google Scholar
    • 12 : Continuing controversy over monitoring men with localized prostate cancer: a systematic review of programs in the prostate specific antigen era. J Urol2006; 176: 439. LinkGoogle Scholar
    • 13 : Determining dosing intervals for luteinizing hormone releasing hormone agonists based on serum testosterone levels: a prospective study. J Urol2007; 177: 2132. LinkGoogle Scholar
    • 14 : Early development of castrate resistance varies with different dosing regimens of luteinizing hormone releasing hormone agonist in primary hormonal therapy for prostate cancer. Urology2011; 77: 412. Google Scholar
    • 15 : Population-based study of survival after osteoporotic fractures. Am J Epidemiol1993; 137: 1001. Google Scholar
    • 16 : Race and sex differences in mortality following fracture of the hip. Am J Public Health1992; 82: 1147. Google Scholar
    • 17 : Public health impact of osteoporosis. J Gerontol A Biol Sci Med Sci2013; 68: 1243. Google Scholar
    • 18 : Impact of trainee involvement with robotic-assisted radical prostatectomy. J Robot Surg2013; 7: 289. Google Scholar
    • 19 : Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy. Urol Ann2014; 6: 142. Google Scholar
    • 20 : Osteoporosis disease management: what every orthopaedic surgeon should know. J Bone Joint Surg Am2009; 91: 79. Google Scholar
    • 21 : Ten-year hip fracture incidence rate trends in a large California population, 1997-2006. Osteoporos Int2013; 24: 373. Google Scholar
    • 22 : Osteoporosis management program decreases incidence of hip fracture in patients with prostate cancer receiving androgen deprivation therapy. Urology2013; 81: 1010. Google Scholar
    • 23 : The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine). Washington, DC: The National Academies Press2007. Google Scholar