Login to Access Video or Poster Abstract: MP32-13
Sources of Funding: AUA Data Grant

Introduction

American Urological Association (AUA) guidelines for NMIBC management were released in 1999 and updated in 2007 and 2016. Chamie et al identified suboptimal compliance with guidelines from 1992-2002. The purpose of this study was to update this analysis and identify if dissemination of guidelines has improved urologic care delivery. In addition, we sought to develop pilot data to drive a future state-wide quality improvement initiative._x000D_

Methods

We identified 865 Iowans in Surveillance, Epidemiology, and End Results (SEER)-Medicare (1992-2009) with a diagnosis of high-grade NMIBC who survived 2 years and were not treated with cystectomy or radiation therapy. Patients were assessed for compliance with guideline-based utilization of perioperative Mitomycin C, instillations, cystoscopy, cytology, and Bacillus Calmette-Guerin (BCG) during 2 years of follow-up.

Results

During the 2-year follow-up period, the appropriate utilization of mitomycin C perioperatively showed significant improvement, increasing from 2.5% to 28.2% between 1992-1997 to 2004-2009 (p<0.01). Individual patients received an average of 6.22 (SD: 6.46) BCG instillations, 4.89 (SD: 1.78) cystoscopies, and 1.77 (SD: 2.13) cytologies. These averages did not increase over the study period. Compliance analysis (Table 1) showed only 40% of patients received at least 1 cystoscopy, 1 cytology, and 1 BCG instillation. Significant predictors of compliance included tumor stage (Tis vs. Ta; OR: 3.0, CI 95% 1.8-5.0; p<0.01) and care at an academic cancer center (vs. non-academic; OR: 9.31, CI 95% 5.6-15.5; p<0.01). Age, gender, marital status, T1 vs. Ta and Charlson comorbidity index were not associated with compliance (all p > 0.05).

Conclusions

With respect to process measures of high-quality NMIBC care, the delivery of perioperative mitomycin improved over time while other care did not improve. The lack of improvement and the variability in care delivery imply that further efforts are needed to improve the dissemination and implementation of guideline-based care. Improving compliance via state-wide quality improvement initiatives, including education and outreach, represents a target for NMIBC quality improvement.

Funding

AUA Data Grant