The Quality of Care Provided to Women with Urinary Incontinence in 2 Clinical Settings

Jennifer T Anger; Alexandriah Alas; Mark S Litwin; Stephanie D Chu; Catherine Bresee; Carol P Roth; Rezoana Rashid; Paul Shekelle; Neil S Wenger

doi:10.1016/j.juro.2016.05.005

The Quality of Care Provided to Women with Urinary Incontinence in 2 Clinical Settings

J Urol. 2016 Oct;196(4):1196-200. doi: 10.1016/j.juro.2016.05.005. Epub 2016 May 7.

Authors

Jennifer T Anger¹, Alexandriah Alas², Mark S Litwin³, Stephanie D Chu⁴, Catherine Bresee⁵, Carol P Roth⁶, Rezoana Rashid⁷, Paul Shekelle⁸, Neil S Wenger⁹

Affiliations

¹ Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California. Electronic address: angerj@cshs.org.
² Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California.
³ Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California.
⁴ Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
⁵ Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California.
⁶ Southern California Evidence-Based Practice Center, RAND Corp., Santa Monica, California.
⁷ Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California.
⁸ Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Veterans Administration Greater West Los Angeles Medical Center, Los Angeles, California; Southern California Evidence-Based Practice Center, RAND Corp., Santa Monica, California.
⁹ Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Veterans Administration Greater West Los Angeles Medical Center, Los Angeles, California.

Abstract

Purpose: Our aim was to test the feasibility of a set of quality of care indicators for urinary incontinence and at the same time measure the care provided to women with urinary incontinence in 2 clinical settings.

Materials and methods: This was a pilot test of a set of quality of care indicators. A total of 20 quality of care indicators were previously developed using the RAND Appropriateness Method. These quality of care indicators were used to measure care received for 137 women with a urinary incontinence diagnosis in a 120-physician hospital based multispecialty medical group. We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of ACOVE (Assessing Care of Vulnerable Elders Project). As a post-hoc secondary analysis, the 2 populations were compared with respect to quality, as measured by compliance with the quality of care indicators.

Results: In the ACOVE population, 37.7% of patients with urinary incontinence underwent a pelvic examination vs 97.8% in the multispecialty medical group. Only 15.6% of cases in the multispecialty medical group and 14.2% in ACOVE (p = 0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index of greater than 25 kg/m(2) were counseled about weight loss in either population (20.9% multispecialty medical group vs 26.1% ACOVE, p = 0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking and only 9.3% of eligible cases (multispecialty medical group only) had documentation of the risks of mesh.

Conclusions: Quality of care indicators are a feasible means to measure the care provided to women with urinary incontinence. Care varied by population studied and yet deficiencies in care were prevalent in both patient populations studied.

Keywords: female urogenital diseases; quality indicators, health care; quality of health care; urinary bladder; urinary incontinence.

MeSH terms

Disease Management*
Exercise Therapy / methods*
Feasibility Studies
Female
Humans
Middle Aged
Pilot Projects
Primary Health Care / standards*
Quality Indicators, Health Care*
Quality of Health Care*
Urinary Incontinence / therapy*

Grants and funding

K23 DK080227/DK/NIDDK NIH HHS/United States