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Urology. 2011 Jul;78(1):3-9. doi: 10.1016/j.urology.2010.12.087. Epub 2011 May 23.

Urologist compliance with AUA best practice guidelines for benign prostatic hyperplasia in Medicare population.

Author information

1
Division of Urology Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. stropes@wudosis.wustl.edu

Abstract

OBJECTIVES:

To improve benign prostatic hyperplasia (BPH) care, the American Urological Association created the best practice guidelines for BPH management. We evaluated the trends in use of BPH-related evaluative tests and the extent to which urologists comply with the guidelines for these 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. The trends in use of BPH-related testing were determined. After classifying urologists by compliance with the best practice guidelines, the models were fit to determine the differences in the use of BPH-related testing among urologists. Additional models were used to define the extent to which individual BPH-related tests influenced guideline compliance.

RESULTS:

The use of most BPH testing increased with time (P<.001) except for prostate-specific antigen (declined; P<.001) and ultrasonography (P=.416). Northeastern and Midwestern urologists were more likely to be in the lowest compliance group compared with Southern and Western urologists (29%, 27%, 13%, and 19%, respectively; P=.01). The testing associated with high guideline compliance included urinalysis and prostate-specific antigen measurement (P<.01 for both). Prostate ultrasonography (P=.03), cystoscopy (P<.01), uroflow (P<.01), and postvoid residual urine volume determination (P=.02) were associated with low guideline compliance. Urodynamics, postvoid residual urine volume, cytology, serum creatinine, and upper tract imaging were not strongly associated with guideline compliance.

CONCLUSIONS:

Despite the American Urological Association guidelines for BPH care, wide variations in the evaluation and treatment were seen. Improving guideline adherence and reducing variation could improve BPH care quality.

PMID:
21601254
PMCID:
PMC3126893
DOI:
10.1016/j.urology.2010.12.087
[Indexed for MEDLINE]
Free PMC Article

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