The Delivery of Prostate Cancer Care in the United States: Implications for Delivery System Reform

Purpose: Since health care in the United States is fragmented and expensive, 1 reform option focuses on improving care coordination as in the medical home model. To better understand care coordination in the context of prostate cancer we examined how the delivery of prostate cancer care is partitioned across primary care providers and specialists. Materials and Methods: We identified 105,961 patients diagnosed with prostate cancer between 1992 and 2005 using Surveillance, Epidemiology and End Results-Medicare data. We assigned all health care for prostate cancer and non-prostate cancer diagnoses by provider specialty across 3 distinct phases of care, including initial, continuing care and end of life. We then identified service types and proportions of care across specialties. Results: Urologists provided most prostate cancer care (45.2%). Radiation oncologist involvement decreased from 27.4% of claims in the initial phase to 5.5% and 5.7% in the continuing care and end of life phases, respectively. Conversely medical oncology and to a lesser degree primary care captured a greater percent of ongoing prostate cancer care. In patients with prostate cancer 7,120,343 of 36,837,904 services (19.3%) were directly related to prostate cancer care. Primary care providers were responsible for 47% of overall health care in men with prostate cancer. Conclusions: Urologists provided most prostate cancer care while primary care providers were responsible for most overall health care in men with prostate cancer. In light of current reforms directed at improving care coordination urologists serve as a logical starting point to improve care delivery in the broader context of a medical home.