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

Abstract

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.

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References (24)

  1. Committee on Quality of Health Care in America IoM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2001.
  2. Roehrborn, C.; McConnell, J.; Barry, M. American Urological Association Guideline on the Management of Benign Prostatic Hyperplasia (BPH). American Urological Association; 2003.
  3. Wennberg JE. On the status of the Prostate Disease Assessment Team. Health Serv Res. 1990; 25:709-716. [PubMed: 1701420]
  4. Sung JC, Curtis LH, Schulman KA, Albala DM. Geographic variations in the use of medical and surgical therapies for benign prostatic hyperplasia. J Urol. 2006; 175:1023-1027. [PubMed: 16469610]
  5. Yu X, McBean AM, Caldwell DS. Unequal use of new technologies by race: the use of new prostate surgeries (transurethral needle ablation, transurethral microwave therapy and laser) among elderly Medicare beneficiaries. J Urol. 2006; 175:1830-1835. discussion 1835. [PubMed: 16600772]
  6. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in america project: benign prostatic hyperplasia. J Urol. 2008; 179:S75-S80. [PubMed: 18405761]
  7. Wharam JF, Sulmasy D. Improving the quality of health care: who is responsible for what? JAMA. 2009; 301:215-217. [PubMed: 19141771]
  8. Berwick DM. Measuring physicians' quality and performance: adrift on Lake Wobegon. JAMA. 2009; 302:2485-2486. [PubMed: 19996408]
  9. Nichol MB, Knight TK, Priest JL, Wu J, Cantrell CR. Nonadherence to clinical practice guidelines and medications for multiple chronic conditions in a California Medicaid population. J Am Pharm Assoc (2003). 2010; 50:496-507. [PubMed: 20621868]
  10. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002; 40:IV-3-IV-18.
  11. Strope SA, Elliott SP, Smith A, Wlit TJ, Wei JT, Saigal CS. Urologist Practice Styles in the Initial Evaluation of Elderly Men with BPH Urology. 2010 in press.
  12. Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001; 345:99-106. [PubMed: 11450679]
  13. Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D. A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Ann Epidemiol. 2007; 17:584-590. [PubMed: 17531502]
  14. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999; 282:1458-1465. [PubMed: 10535437]
  15. Shea AM, DePuy V, Allen JM, Weinfurt KP. Use and perceptions of clinical practice guidelines by internal medicine physicians. Am J Med Qual. 2007; 22:170-176. [PubMed: 17485558]
  16. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. JAMA. 2009; 301:868-869. [PubMed: 19244197]
  17. Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC Jr. Scientific evidence underlying the ACC/ AHA clinical practice guidelines. JAMA. 2009; 301:831-841. [PubMed: 19244190]
  18. McConnell, JD.; Barry, MJ.; Bruskewitz, RC.; Bueschen, AJ.; Denton, SE.; Holtgrewe, HL. Agency for Health Care Policy and Research PHS. Rockville, Md: U.S. Department of Health and Human Services; 1994. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guideline. vol. AHCPR publication No. 94-0582
  19. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004; 46:547-554. [PubMed: 15474261]
  20. Kessler D, McClellan M. Do Doctors Practice Defensive Medicine? The Quarterly Journal of Economics. 1996; 111:353-390.
  21. Hollingsworth JM, Hollenbeck BK, Daignault S, Kim SP, Wei JT. Differences in initial benign prostatic hyperplasia management between primary care physicians and urologists. J Urol. 2009; 182:2410-2414. [PubMed: 19765742]
  22. Lin GA, Redberg RF, Anderson HV, Shaw RE, Milford-Beland S, Peterson ED, Rao SV, Werner RM, Dudley RA. Impact of Changes in Clinical Practice Guidelines on Assessment of Quality of Care. Med Care. 2010; 48:733-738. [PubMed: 20613660]
  23. Robinson JC, Williams T, Yanagihara D. Measurement of and reward for efficiency In California's pay-for-performance program. Health Aff (Millwood). 2009; 28:1438-1447. [PubMed: 19738261]
  24. Linder JA, Kaleba EO, Kmetik KS. Using electronic health records to measure physician performance for acute conditions in primary care: empirical evaluation of the community-acquired pneumonia clinical quality measure set. Med Care. 2009; 47:208-216. [PubMed: 19169122]