Evaluating the quality of urinary incontinence and prolapse treatment (EQUIPT) study: Quality indicator development for pelvic organ prolapse

Pelvic organ prolapse (POP) is very common, and it is the indication for more than 200,000 surgeries in the United States annually. It is estimated that the number of women seeking care for a POP will increase by 45% over the next few years. With the ultimate goal of measuring the quality-of-care provided to women with pelvic floor disorders, we sought to develop and rate a set of quality-of-care indicators for the work-up and management of POP. Quality indicators (QI) have been used to measure structure, process, and outcomes measures of care provided for many diseases. They are useful in identifying deficits in adherence to recommended process for basic care which can pose serious threats to the health of the American public.

An extensive literature review was performed to develop a set of 19 potential QIs for the management of POP. QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. The indicators were then presented to a panel of nine experts who were asked to rate the indicators on a nine-point scale for both validity and feasibility. Using the RAND Appropriateness Method, analysis was performed on preliminary rankings of each indicator. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group. Indicators were rated a second time individually using the same nine-point scale. Based on the post-discussion ratings, QIs receiving a median score of greater than or equal to 7 were passed.

QIs were developed that addressed screening, diagnosis, work-up, and both nonsurgical and surgical management. Areas of controversy included whether screening should be performed to identify prolapse, whether pessary users should undergo a vaginal exam by a health professional every 6 months versus annually, and whether a colpocleisis should routinely be offered to older women planning to undergo surgery for POP. Controversy also centered on whether a prophylactic sling should be offered at the time of prolapse surgery. Following the expert panel discussion, 12 of 18 potential indicators were determined to be valid for pelvic organ prolapse with a median score of 7 or greater.

We developed and rated twelve potential QIs for the care of women with POP. Once these QIs are tested for feasibility they will be applied on a national level to measure the quality of care provided to women with POP in the United States.