EAU15: Measuring and improving prostate cancer care

Sun, 22 Mar 2015

Medical coverage in the United States presents unique challenges related to costs. They can be tackled through enabling partnerships between the medical community and insurance companies, but most importantly, by thinking out of the box.

One example of collaboration to improve prostate cancer care through joint efforts is the MUSIC Project, currently being implemented in Michigan.

The main goals of the MUSIC project are the measurement of peri-operative morbidity, analysis of patient-reported functional outcomes, and the assessment of technical skills.

“We were not measuring winners or losers, but measuring to improve,” said David Miller (US). Technical skills assessment can become a performance measurement and can be used for resident evaluation. Eventually, this could lead to hospital credentialing, hiring and board certification. Most importantly, it can lead to collaborative learning, and improvement.

Assessments are costly, so the group tried a new approach: what if the ‘wisdom of the crowd’ could help lower the costs while maintaining the quality of the evaluation? They turned to crowdsourcing.

Seventy-six video clips from 12 different stages of robotic prostatectomies were recorded and shown to at least four expert reviewers, and between 30 and 55 online crowd-sourced reviewers. The results were surprising: “We got 1,500 valid crowd scores in less than nine hours, and a strong correlation between crowd and expert grades,” Miller added. This was especially true for the rank order of lower scoring surgeons.

The crowd provided very detailed and useful feedback, despite lack of medical training. Therefore, video assessment by peers or the crowd is feasible and this approach shows that even the non-specialist group is able to identify measurable differences in surgical techniques from medical professionals. In order to establish crowdsourcing as an assessment tool these preliminary results should, and will, be confirmed with a larger sample size, and the skill scores correlated with perioperative and functional outcomes.

“Undoubtedly, better skills will lead to improved patient care and more effective and efficient healthcare, which will ultimately benefit physicians, patients and payers,” said Miller.