Previous studies noted varied adherence to clinical practice guidelines (CPGs), but studies are yet to quantify adherence to American Urological Association BPH guidelines. We studied guideline adherence in the context of a new quality improvement collaborative (QIC).
Data were collected as part of a statewide QIC. Medical records for patients undergoing select CPT codes from January 2020 to May 2022 were retrospectively reviewed for adherence to selected BPH guidelines.
Most men were treated with transurethral resection of the prostate. Notably, 53.3% of men completed an IPSS and 52.3% had a urinalysis. 4.7% were counseled on behavioral modifications, 15.0% on medical therapy, and 100% on procedural options. For management, 79.4% were taking alpha-blockers and 59.8% were taking a 5-ARI. For evaluation, 57% had a PVR, 63.6% had prostate size measurement, 37.4% had uroflowmetry, and 12.3% were counseled about treatment failure. Postoperatively, 51.6% completed an IPSS, 57% had a PVR, 6.50% had uroflowmetry, 50.6% stopped their alpha-blocker, and 75.0% stopped their 5-ARI.
There was adherence to preoperative testing recommendations, but patient counseling was lacking in the initial work-up and preoperative evaluation. We will convey the data to key stakeholders, expand data collection to other institutions, and devise an improvement implementation plan.
Lower urinary tract symptoms. 2024 Jul [Epub]
Eric Wahlstedt, John Lee Graves, John Wahlstedt, Alison D'Alessandro, Will Cranford, Nicholas A Freidberg, Amul Bhalodi, John R Bell, Andrew James, Jason Bylund, Stephen E Strup, Andrew Harris
College of Medicine, University of Kentucky, Lexington, Kentucky, USA., Department of Urology, University of Kentucky, Lexington, Kentucky, USA., Thomas Jefferson SKMC, Philadelphia, Pennsylvania, USA., Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA., Urology of Austin, Austin, Texas, USA., Department of Urology, Baptist Health, Lexington, Kentucky, USA., Texas Urology Group, San Antonio, Texas, USA.