AQUA Registry Data Support Move to Value-Based Care in Urology

The American Urological Association (AUA) Quality (AQUA) Registry is one example of how registries and national data sets can provide the data needed to promote and further value-based care, said Matthew Nielsen, MD, FACS, chair, Department of Urology, University of North Carolina School of Medicine.

This transcript has been lightly edited for clarity.

Transcript

How is the data in AQUA increasingly important as more reimbursement models move toward value-based payments?

That’s a really great question. The whole movement toward value-based care is something that has been talked about for many years, and the momentum in that direction is really starting to pick up the pace. Registries like AQUA are really helpful, because they provide specialty-specific outcomes data and process measures that we can then provide to testify to the level of quality of care that's being delivered.

When we talk about value-based care, we talk about sort of quality related to cost, and cost is relatively easier to measure. Quality is more complicated to measure. Having really sophisticated solutions like AQUA is really helpful. Many of our members in their local health systems or in their local communities find the ability of AQUA to fulfill those needs useful. Then, with government programs that often require these quality reporting measures, it's really helpful to be able to demonstrate the value of urology care.

Another space that AQUA has been helpful for is for us to report broadly about the nature of urology practice and the kind of care that patients are getting around the country. There was a really important development after PSA [prostate-specific antigen] screening started for prostate cancer, where a concept that we call active surveillance was developed where a man may go through PSA screening and may have a prostate cancer diagnosed, but it may be a type of prostate cancer that poses a very low risk for him in his lifetime. As it happens, a very large fraction of men who have a prostate cancer diagnosed with PSA screening qualify for active surveillance.

There have been, historically, a lot of concerns about over treatment of men with low-risk prostate cancer, and there was, a little bit over 10 years ago, a strong movement to move away from PSA screening. We as urologists, on behalf of our patients, were not enthusiastic about that movement, because we have no other explanation other than PSA screening to explain the really dramatic transformation of prostate cancer outcomes in men in countries like the US where PSA screening was taken up. We were able to use national data sets to come back to the organizations that made those recommendations against PSA screening and demonstrate that as urologists learned about how active surveillance works, and through organizations like the AUA and others who spread education and supported the research to show that active surveillance could work, the rates of men who underwent active surveillance went up over time, and particularly those men with lower-risk disease.

In 2018, when a large national organization that earlier was very not enthusiastic about PSA screening saw that demonstrable increase in active surveillance, they actually changed their recommendation, walked it back and said that PSA screening could be something that patients may do [with] sort of shared decision-making and that the benefits and harms of screening would be different with active surveillance. Those data that changed that recommendation in 2018 weren't from AQUA, but they were from a different national registry that is no longer available, and AQUA has stepped into that void to fill the gap.

We're really hopeful that for that specific example and for lots of other examples with common urology conditions, AUA can help support and share that message of value-based care broadly to show all the ways that urologists are doing research to understand better ways of taking care of patients, spreading that research around the community of practice, and not just having people take our word for it, but being able to demonstrate with data and things like AQUA that practice is changing and that people are constantly learning.