Summary

The Martini-Klinik, a specialist prostate cancer clinic in Germany, systematically measures the quality of its care using outcomes that are most relevant to patients. Examples include rates of incontinence and erectile dysfunction following treatment. These data are shared with the healthcare professionals at the clinic to continually revise and improve care.1 As a result, the Martini-Klinik consistently performs better than the German national average in terms of treatment outcomes for patients with prostate cancer.2

 

Problem

Following prostate cancer treatment, healthcare providers will often test a patient’s prostate-specific antigen (PSA) levels to determine whether treatment has been successful. But measuring treatment success solely based on PSA levels fails to recognise other important determinants of success, including patients’ quality of life after treatment. Prostate cancer treatments, such as radical prostatectomies, can lead to incontinence, erectile dysfunction and impotence.1 These treatment risks represent important outcomes for patients, especially as the age of diagnosis for prostate cancer is decreasing.3

Solution

The Martini-Klinik – a specialist prostate cancer clinic in Hamburg, Germany – systemically measures the quality of its surgical procedures based on outcomes that are most relevant to its patients. These outcomes include rates of incontinence, erectile dysfunction, bowel irritation and surgical complications, in line with recommendations from the International Consortium for Health Outcomes Measurement (ICHOM).4

Outcomes data are shared with the healthcare professionals at the Martini-Klinik, forming the basis of a continuous cycle of knowledge-sharing and care improvement.1 The results are also publicly available on the Martini-Klinik website, enabling prostate cancer patients and healthcare providers to review and understand potential treatment options based on relevant outcomes.5

Outcomes data are collected at three points – 7 days, 6 months and 1 year after surgery – and patients have yearly follow-up questionnaires for the rest of their lives. Data are collected from all German, Norwegian and English-speaking patients, representing 90% of the clinic’s patient population.6

In 2012, one third of Martini-Klinik patients had full private health insurance. Publicly insured patients were admitted and reimbursed for the Martini-Klinik through the associated public university hospital (Hamburg-Eppendorf).1

 

What has it achieved?

The Martini-Klinik has the largest prostate cancer treatment programme in the world, with over 5,000 outpatient cases and 2,400 surgical cases seen every year. Approximately 75% of patients are referred to the Martini-Klinik by an outpatient urologist, and 25% of patients are seeking a second opinion on previous diagnoses or treatment options. Each surgeon conducts between 200 and 300 procedures per year.1

The clinic consistently performs better than the national German average in terms of treatment outcomes and quality of life in prostate cancer patients (see Table 1).2 5

Table 1. Martini-Klinik patient outcomes compared to the national German average after prostate cancer treatment (2012)

Results German average  Martini-Klinik 
Fully continent* 56.7% 93.5%
Severe incontinence** 4.5% 0.4%
Severe erectile dysfunction (1 year)*** 75.5% 34.7%
Ureteral injury 0.6% 0.04%
Sepsis 2.5% 0.04%
Pulmonary embolism 0.8% 0.1%
Delayed wound healing 1.7% 0.9%
Rectal injury 1.7% 0.2%
Thrombosis 2.5% 0.4%

*Fully continent = incontinence pads are unnecessary or only used for safety
**Severe incontinence = more than 5 incontinence pads used each day
***Including patients suffering from erectile dysfunction prior to the operation

 

Further information

References:

  1. Porter ME, Deerberg-Wittram J, Marks C. 2014. Martini Klinik: prostate cancer care. Harvard Business School Case: 714-471
  2. Martini Klinik. 2012. BARMER GEK Krankenhaus report. Hamburg: Martini Klinik
  3. Tilki D, Maurer V, Pompe RS, et al. 2019. Tumor characteristics, oncological and functional outcomes after radical prostatectomy in very young men ≤ 45 years of age. World J Urol Available here: https://doi.org/10.1007/s00345-019-02740-8 [accessed: May 2019]
  4. ICHOM. Localised prostate cancer: the standard set. Available here: https://www.ichom.org/portfolio/localized-prostate-cancer/ [accessed: May 2019]
  5. Martini Klinik. Results. Available here: https://www.martini-klinik.de/en/results/ [accessed: March 2019]
  6. Loppow D. 2019. Interview with Aneri Nanavaty and Shannon Boldon at The Health Policy Partnership.
  7. Prostate Cancer Outcomes (PCO) Study. Information on the study. Available here: https://www.pco-study.com/info [accessed: April 2019]