Vanderbilt Center for Surgical Quality Outcomes Research

Projects on their own page

• CeasarData
  • CeasarProjTxVars
• CeasarProject (Mainly Aim 1 / Primary analysis)
• CeasarAim1ThreeYear
• CeasarAim2
• CeasarRadiation Dan Lee, a research fellow, and Karen Hoffman are working on these.
• Completed projects
  • PcosStudy
  • ProstateCancerQualityOfCare
  • RoboticVsOpenProstatectomy
  • OpenRobotCystectomyRecovery
  • ActiveSurveillance (Dan Barocas' R03)
  • HematuriaProject (Dan Barocas' R03)
  • CeasarActiveSurveillanceCohort (Should be complete.) Max Lang, a medical student, and Mark Tyson led this project.

Notes for projects with the Vanderbilt Center for Surgical Quality Outcomes Research

Karen Hoffmann radiation paper

• on PCOS data (she will also be doing a similar study in the Ceasar cohort, separately.)
• could also do the same thing w/ surgery
• Purpose is to report 15 year outcomes on rad patients. Anticipate a small sample size because few patients will survive that long.
• Also to find predictors of outcomes like functional status
• Outcomes: sex, urine, and bowel function scores and bother scores. One is 0-100. There are several more domains within each of sexual function, urine, and bowel.
• Want to look at the outcomes separately by tx: radiation and surgery
• 3 observations (including baseline?) Some will have only 1 or 2.
• Need to refine the outcome definition. Percent change? NO! Difference from baseline? Return to bl (Y/N)?
• Recommended modeling the post rad assessments as a function of the bl assessment (not a change measurement.)
• I proposed using curveRep()? in rms/Hmisc to show representative curves. Sent email with details to TK.
• Project 2: looking at radiation patients only, model QOL (functional status) over time as a function of bl function and other bl variables.

CHOICE CEASAR extension grant, Dan Barocas

• Dan is applying for a new grant. The part we'll be interested in is developing a quality index for research use.

Meeting 2013 June 3

• Ceasar study is an observational comparative effectiveness study of treatments for prostate cancer. It has five sites. Patients are followed over time.
• Structure: qualifications of MD, resources
• Process: imaging, lymphadenectomy, communication with PCP
• Stakeholder involvement:
  • Include patients, payers, providers, hospital administrators
  • Perhaps develop a separate index for each group?
  • They need to help us prioritize the quality measures, and perhaps rank the outcomes in terms of importance –it may be that a composite outcome is best, comprised of urinary/sexual/bowel function, satisfaction, complications and cancer control = QUEST. Patients won't care much about efficiency, but will care about safety. Payers will care about efficiency, and will care about quality and safety as they pertain to cost. etc.
• Quality Measures: Need to compose a list of candidate measures
• Independent variables (other than the quality measures): age, race, SES, disease characteristics, psychosocial measures, treatment in some models (some models will apply to only one treatment)
• Outcome Measures: May need to make a composite of function/complication/satisfaction/cancer control. Alternatively, we could select the most important outcome for each stakeholder group and the others could be secondary - e.g., since virtually all patients survive, we could look at QOL as the main outcome and look at others as secondary
  • Cancer control is one outcome measure. It could be measured by PSA recurrence, need for further therapy, radiographical recurrence, biopsy-proven recurrence.
• Modeling: Variable selection (beyond the base model) is the key. How to select – stakeholder opinion, a-priori selection, forward or backward stepwise (frowned upon), LASSO (Least Absolute Shrinkage…) technique.
  • Consider one model per stakeholder (with composite outcome) rather than multiple models per stakeholder (with multiple outcomes). But different stakeholders may value different outcomes differently???
• Order of Operations

1. Link datasets (Aim 1 of current extension)
2. Build base model (satisfying Aim 1 and 2 of parent CEASAR grant)
3. Test individual candidate quality of care measures. These were originally proposed by a Delphi group (perhaps limit to those with satisfactory capture, or those that stakeholders believe have face validity) (Aim 2 of current extension)
4. Variable selection for inclusion in final model (perhaps with stakeholder involvement)
5. Build final model, including systematically selected quality measures/ Develop a quality index (Aim 3 of current extension)
   • Could use LASSO!
6. Measure the contribution to the outcome of the quality measures collectively, and individually.

• Open questions
  • Optimal method for selecting variables
  • Optimal modeling technique (based in part on whether or not we use a composite outcome; we could select the most important outcome for each stakeholder group and the others could be secondary - e.g., since virtually all patients survive, we could look at QOL as the main

• • Patient-level model??? Wouldn't it make more sense to develop a quality score for each provider and for each facility??
  • Think about relationship between hospital type (teaching, research, community), travel distance, SES, and outcome. (Travel distance is relatively low priority)

U51 O'Brien grant proposal, Jay Fowke's project

• This is one of 3 projects in this proposal
• Looks at associations between obesity and immunologic gene expression in prostate and between gene expression and lower urinary tract symptoms LUTS.
• How does body fat impact the prostate. (The impact has already been established.)

Meeting 2012 November 12, JoAnn and Tatsuki

• Read to understand pathway analysis better. They will use a signature t-score method.

Meeting 2012 November 9

• They will measure gene expression in 511 candidate genes that regulate immune response in prostate tissue.
• They can probably get about 500 patients, and we need to explain what they can detect.
• Recruiting mainly at Urology Associates
• Sample population is patients who get a prostate biopsy that are not found to have cancer or precancerous lesions.
• Of those biopsied, about one third have cancer.
• Data collected: interview, chart, blood, urine, bmi, body fat percentage, waist circumference, waist-hip ratio
• LUTS is measured by a 7-item scale ranging from 0-35. It is right skewed with a mean of 7.
• Aim 3 involves reassessing LUTS after 5 years. Expect 80% retention for sample size of 400.
• Gene expression is a count of the affected ___ in each gene.
• We can use lasso as a variable selection technique to choose the important genes.

• Set ALLOWTOPICCHANGE = TatsukiKoyama, JoAnnAlvarez, SharonPhillips, AlexZhao, LichingHuang