236334 Evaluating the quality of urinary incontinence and prolapse treatment (EQUIPT) study: Quality indicator development for pelvic organ prolapse

Tuesday, November 1, 2011

Aqsa Khan, MD , Health Services Research Group, UCLA Department of Urology, Los Angeles, CA
Krista Kiyosaki , University of Hawaii Medical School, Honolulu, Hawaii, Los Angeles, CA
Victoria Scott , David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA
Claudia Sevilla , David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA
Sarah E. Connor, MPH, CHES , Urology Health Services Research Group, UCLA, Los Angeles, CA
Carol Roth, RN, MPH , Southern California Evidence-Based Practice Center RAND Corporation, Santa Monica, CA
Mark S. Litwin, MD, MPH , Urology and Health Services, David Geffen School of Medicine at UCLA, Los Angeles, CA
Larissa Rodriguez, MD , Department of Urology, UCLA, Los Angeles, CA
Neil Wenger, MD , Department of Medicine--General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA
Paul Shekelle, MD, PhD , RAND, Santa Monica, CA
Jennifer Anger, MD, MPH , Cedars-Sinai Medical Group & Health Associates, Cedars-Sinai Medical Center, Beverly Hills, CA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
1. Participants will be able to discuss the impact of pelvic floor diseases in the Untied States. 2. Participants will be able to describe the RAND Appropriateness Method for identifying quality of care indicators for the treatment of pelvic organ prolapse.

Keywords: Women's Health, Women's Quality Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a research manager in the UCLA Department of Urology, Health Services Research Group who assisted in the development and implementation of the research being presented. I have over 20 years of research experience in underserved populations, physician-patient communication, and cancer screening and treatment. I have a Master's in Public Health and am a Certified Health Education Specialist.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.