Evaluative Care Guideline Compliance Is Associated With Provision of Benign Prostatic Hyperplasia Surgery
Strope SA, Wei JT, Smith A, Wilt TJ, Saigal CS, Elliott SP; Urologic Diseases in America Project. Urology. 2012 May 18. [Epub ahead of print]

Source

Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.

Abstract

OBJECTIVE:

To determine the impact of evaluative care guideline compliance on surgical intervention for benign prostatic hyperplasia (BPH).

METHODS:

From Medicare claims data, we developed a cohort of men new to a urologist with a diagnosis of BPH. We determined urologists' compliance with guideline recommended care (3 months) and their time- and geography-standardized average monthly Medicare expenditures (1 year). At the level of the urologist, we assessed the impact of these measures on the use of surgical therapy within 1 year of the new patient visit.

RESULTS:

Of 10 248 patients in the cohort, 675 received surgical intervention (6.7%). Guideline compliance (2% received surgery in highest quintile; 11% lowest quintile) was associated with surgical intervention. The results were robust to adjustment for patient and surgeon factors (Guideline Compliance, odds ratio = 0.09; 95% confidence interval = 0.06-0.15, highest to lowest adherence).

CONCLUSION:

Urologists who tend to follow the AUA best practice guidelines for BPH evaluation perform surgical interventions on their BPH patients less frequently than urologists who do not follow these guidelines.