Urologist Compliance With AUA Best Practice Guidelines for Benign Prostatic Hyperplasia in Medicare Population (original) (raw)

Objectives-To improve BPH care, the American Urological Association created best practice guidelines for BPH management. We evaluate trends in use of BPH related evaluative tests and the extent to which urologists comply with the guidelines for evaluative tests. Methods-From a 5% random sample of Medicare claims from 1999 to 2007, we created a cohort of 10,248 patients with new visits for BPH to 748 urologists. Trends in use of BPH related testing were determined. After classifying urologists by compliance with best practice guidelines, models were fit to determine the differences in use of BPH related testing among urologists. Further models defined the extent to which individual BPH related tests influenced guideline compliance. Results-Use of most BPH testing increased over time (p < 0.001) except PSA (declined; p < 0.001) and ultrasound (p=0.416). Northeastern and Midwestern urologists were more likely to be in the lowest compliance group compared to Southern and Western urologists (29%, 27%, 13% and 19% respectively; p = 0.01). Testing associated with high guideline compliance included urinalysis and PSA (p < 0.01 for both), while prostate ultrasound (p = 0.03), cystoscopy (p < 0.01), uroflow (p < 0.01), and post void residual (p = 0.02) were associated low guideline compliance. Urodynamics, PVR, cytology, serum creatinine, and upper tract imaging were not strongly associated with guideline compliance. Conclusion-Despite the AUA guidelines for BPH care, wide variations in evaluation and treatment are seen. Improving guideline adherence and reducing variation could improve BPH care quality.