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MUSIC (Michigan Urological Surgery Improvement Collaborative)

Prostate cancer care is both expensive and highly variable in terms of quality and cost-efficiency. Urology practices provide the majority of prostate cancer-related services and represent a logical focal point for efforts aimed at improving the value of prostate cancer care. However, the ability of urologists to improve care delivery in this remains limited by two significant concerns. First, most urologists have little or no data regarding the quality of care provided in their own practice. Second, even when such “quality data” are available, few understand how to change their practice in order to achieve actual improvements.

Recognizing these concerns, and the promising results achieved with physician-led quality collaboratives in other disciplines, Drs. David Miller and Jim Montie have now partnered with Blue Cross Blue Shield of Michigan to create the Michigan Urological Surgery Improvement Collaborative (MUSIC). The MUSIC team has already made substantial progress toward developing a consortium of urology practices, including commitments to participate from a geographically diverse group of practices that comprise nearly 20% of urologists in Michigan.

MUSIC participants will focus their initial efforts on the following goals:

  • To improve patterns of care in the radiographic staging of men with newly diagnosed prostate cancer. MUSIC will use strategies built around comparative performance feedback and guideline dissemination to reduce unnecessary testing in many men at low risk for metastatic disease and to optimize the use of appropriate radiographic staging evaluations among men with higher risk cancers.
  • To reduce variation in the discretionary use of androgen deprivation therapy. Through collaborative data collection, performance feedback, and clinical guideline review, MUSIC will seek to reduce inappropriate utilization of androgen deprivation therapy (ADT) among men with clinically localized disease, as well as to better understand and improve current practice patterns in the timing of ADT among men with metastatic prostate cancer or recurrent cancer after primary therapy.
  • To improve patient-centered decision making among men considering local therapy for early-stage prostate cancer. MUSIC will also seek to use available patient decision aids to improve patient knowledge and participation in treatment decision-making for early-stage prostate cancer. An important outcome metric for this aim will be the distribution of treatments for patients in each practice according to the risk strata defined by existing clinical guidelines.

MUSIC leadership believes that achievement of these aims would significantly improve the quality and cost-efficiency of prostate cancer care in the state of Michigan. The collective benefits of this effort will extend to urologists, Blue Cross Blue Shield of Michigan, and—most importantly—patients with prostate cancer.

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