UH Urology Institute - January 2017
SIMON KIM, MD
Co-director, Center for Quality and Outcomes, University Hospitals Urology Institute; Assistant Professor of Urology, Case Western Reserve University School of Medicine
University Hospitals’ Simon Kim, MD, MPH, Co-director, Center for Quality and Outcomes, University Hospitals Urology Institute, in Ohio; and Assistant Professor of Urology, Case Western Reserve University School of Medicine, is spearheading efforts to reduce health disparities for the treatment of bladder and prostate cancers.
As part of a high-reliability medicine effort at University Hospitals, Dr. Kim is helping to bring better treatment to all patients with bladder cancer—the fifth most common cancer in the U.S. “We recognize that bladder cancer is an aggressive cancer, and many of the treatments carry significant morbidities. Many patients must get chemotherapy and a cystectomy, and there are variations and complications with that procedure. Some of this is unique to that procedure, and some of it is due to health care factors that can impede better outcomes,” Dr. Kim said.
To help address this, University Hospitals has created a high reliability initiative to standardize care, institute evidence-based guidelines for the treatment of bladder cancer patients, and reduce complications.
The high-reliability initiative is system-wide throughout University Hospitals and identifies better care steps before, during, and after a cystectomy is done. Once the initiative is fully developed, it will be available for all urologists in the University Hospitals system to follow. “We want to make sure that the care we delivery is high quality and reproducible,” he said.
The high-reliability medicine efforts at University Hospitals—for bladder cancer and for other diseases and conditions—are part of the current focus on cost-efficient care throughout the U.S.
Decision Aids for Prostate Cancer
Another health care disparity issue addressed by Dr. Kim and colleagues is the development of decision aids for men diagnosed with prostate cancer. “It can be a complicated diagnosis to understand. We are focused on brining the best available evidence to patients, particularly minority patients,” he said. Studies have shown that African-American and Latino men have higher rates of prostate cancer but often receive poorer care.
The computer-based decision aids help facilitate a patient-centered decision about care and are used when the patient meets with his urologist to discuss diagnosis.
As part of the efforts to reduce health care disparities for prostate cancer, yet another area that Dr. Kim and colleagues have studied is readmission to hospitals after surgery. Research shows that minority patients are at a higher risk for readmission, so there is now a tablet-based app to elicit feedback when a patient is at home. Patients can use the app to let providers know about symptoms such as fever, loss of appetite, pain, and nausea/vomiting that they experience. “If they are not doing well, we can call them immediately and talk about ways to troubleshoot and address minor symptoms,” he said. The goal is to intervene before problems get worse and require hospitalization.
Also in progress via Dr. Kim is a national survey of 2,000 physicians who treat prostate cancer to address physician barriers to active prostate cancer surveillance. This could include the burden involved with active surveillance the availability of high-tech treatment options, Dr. Kim said. Survey results are expected in spring 2017.
Yet one more way that University Hospitals clinicians are improving urologic cancer care is with the identification of patients with more aggressive cancers and then making information about their biomarkers available via electronic medical records. This approach could be part of the future of cancer care, Dr. Kim said.
A Seasoned Professional Offering Better Care
Overall, Dr. Kim’s research focuses on improving the quality of care and health outcomes for patients diagnosed with prostate, bladder and kidney cancer. He also has research interests in shared decision-making and health services research. His research group regularly uses administrative data to identify potential care gaps in cancer therapy, and they have published more than 40 papers in this research area.
Dr. Kim was recently awarded a career development award from the Conquer Cancer Foundation of the American Society of Clinical Oncology. He has been independently funded from the National Institutes of Health to develop the aforementioned decision aids for men diagnosed with localized prostate cancer. He has published more than 100 manuscripts in outcomes research for genitourinary cancer and was awarded the Journal of Urology Best Reviewer Award in 2013.