236373 Evaluating the quality of urinary incontinence and prolapse treatment (EQUIPT) study: Quality indicator development for urinary incontinence

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 , Department of 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
The goal of quality assurance in medicine is to preserve and improve patient care. Quality-of-care research evaluates “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Although research on quality has been conducted in many areas of medicine and surgery, there is still a paucity of data regarding the treatment of women with urinary incontinence (UI). UI is a chronic condition affecting over 9 million women in the U.S. with an annual cost of over $450 million. 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 (QIs) for the work-up and management of UI.

An extensive literature review was performed to develop a set of 36 potential QIs for the management of UI. QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. Indicators for the management of stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were also developed. Nine experts rated the indicators on a nine-point scale for both validity and feasibility. Analysis was performed on preliminary rankings of each indicator using the RAND Appropriateness Method. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which the indicators were rated a second time individually using the same nine-point scale. Based on the post-discussion ratings, quality indicators that received a median score of greater than or equal to seven were passed.

QIs were developed addressing prevention, screening, diagnosis, work-up, and both nonsurgical and surgical management. Sixteen indicators addressed general UI, sixteen indicators specifically addressed SUI, and nine addressed UUI. Areas of controversy included whether routine screening for UI should be performed, whether urodynamics should be performed before non-surgical management is initiated, and whether cystoscopy should be performed as part of the work-up of uncomplicated stress incontinence. Following the expert panel discussion, 27 of 41 potential indicators were determined to be valid for urinary incontinence with a median score of 7 or greater.

We developed and ranked 27 potential quality indicators for the care of women with urinary incontinence. 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 UI in the United States. -

Learning Areas:
Chronic disease management and prevention
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 urinary incontinence in women.

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.