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March 2019

Blue Cross Blue Shield of Michigan



Being a patient with prostate cancer means facing uncertainty and having to make difficult decisions. This uncertainty stems from the fact that the screening for prostate cancer is imperfect; treatment options aren’t one size fits all, and there is variation in long-term symptoms between patients who undergo the same treatment.

This uncertainty is currently addressed through the process of shared decision-making, in which patients and urologists work together to arrive at decisions that are medically sound and in line with patient preferences. Shared decision-making is limited by the quality of the information being used to guide the decisions, so when the information presented is not individualized to a patient, uncertainty can remain about what is the best medical decision.

The uncertainty could be reduced by giving patients personalized information about the risks and benefits of each decision they face so patients are well-informed and have answers to the questions relevant to them. Unfortunately, individual urologists usually do not have access to personalized risk estimates for each of the decisions faced by their patients.

The Michigan Urological Surgery Improvement Collaborative (also known as MUSIC), a physician-led quality improvement consortium of urology practices in Michigan working together to improve urologic care for patients across the state, is working to address these needs so that patients and urologists can make shared decisions that are informed by personalized information. MUSIC's effort to use its collective data to guide shared decisions has been termed the askMUSIC initiative. When patients and urologists want access to information that can be used to drive a medical decision, they can now ask MUSIC at a dedicated website,

How is askMUSIC able to provide personalized information to support shared decisions?

One of the main reason’s urologists cannot usually provide patients with personalized information is that individual urologists often do not collect this information. Through statewide participation of more than 40 urology practices (over 90 percent of Michigan’s urologists) and support from Blue Cross Blue Shield of Michigan, MUSIC is able to collect information from patients across the state with the help of data abstractors at each of the participating practices.

Then, for each medical decision faced by patients and urologists, MUSIC is working to develop and validate predictive models that can provide personalized risk estimates using information from similar patients.

Treatment options infograpic

What questions can askMUSIC help with right now? For patients considering whether to undergo a prostate biopsy, askMUSIC can provide personalized information about the risk of finding cancer. For patients newly diagnosed with prostate cancer, askMUSIC can provide guidance on the necessity of imaging for metastatic disease and demonstrate the types of treatments chosen by patients with similar demographic and disease characteristics. For patients who opt for surgery to remove their prostate, askMUSIC can provide personalized information on how invasive and widespread the cancer is likely to be at the time of surgery.

All of this information is powered by data from patients across Michigan. Putting this data into actionable predictive models allows MUSIC to collectively learn from every patient to help the next patient seen by a Michigan urologist.

Patient participation in MUSIC is central to this effort because it guides the work based on patients’ concerns and priorities.

Thanks to cooperation with the Urology Care Foundation, askMUSIC is home to reliable urologic education

Beyond providing personalized information to patients, MUSIC also recognizes the importance of providing accurate and meaningful educational information that is of relevance to all patients with urologic conditions. MUSIC has developed a series of educational pamphlets with information deemed as important to patients, as well as centered around specific quality improvement objectives.

Through the Urology Care Foundation, the official foundation of the American Urological Association, askMUSIC now provides a wealth of written and video educational materials that were developed and vetted by both urologists and patients.

Through a combination of the opportunity for personalized information and offering of educational materials, askMUSIC strives to help patients and urologists in Michigan make the best possible shared decisions for urologic care.

For questions about this article, please email Susan Linsell, Program Manager, MUSIC at

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