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    BPH guideline adherence: ‘Room for improvement’

    Documentation of IPSS least performed measure, researchers report

    Orlando, FL—A retrospective evaluation to determine adherence to the AUA clinical practice guideline for the management of lower urinary tract symptoms/BPH among urologists practicing in an academic setting found generally positive results, but with room for improvement, researchers reported at the AUA annual meeting in Orlando, FL.

    The study, conducted at Northwestern University, Chicago, used an automated electronic medical record extraction process to identify information from within clinical documentation and orders for first BPH/LUTS-related visits. The data were analyzed to determine rates at which individual diagnostic tests and portions of the history and physical exam addressed in the AUA guideline were performed. 

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    The study included data from 3,494 new visits among men age ≥45 years seen by 12 urologists over a 5-year period (January 2008 to December 2012). Its results showed physician adherence rates ranged from 53.0% to 98.2% for the nine measures that are “recommended” by the AUA guideline for the initial evaluation of a patient with basic LUTS/BPH. The five “not routinely recommended” measures were performed no more than 10% of the time.

    “This is a single-center analysis performed in an academic institution. Therefore, the findings may not be nationally generalizable, and so further study in more diverse practice settings would be useful,” said first author Gregory B. Auffenberg, MD, urology resident at Northwestern.

    “We feel our analysis provides an important benchmark for comparative research of guideline adherence in different practice settings, and that as a benchmark, it will allow important future analyses to evaluate the effect of guideline adherence on patient outcomes,” added Dr. Auffenberg, who worked on the study with Christopher M. Gonzalez, MD, MBA, and co-authors.

    In order to establish the accuracy of the automated data extraction, a manual review was performed to extract data from 360 randomly chosen patient charts. This validation process revealed an overall concordance rate of 96.7% between the automated and manual techniques, providing reasonable confidence in the accuracy of the reported results, Dr. Auffenberg said.

    Next: Lowest adherence seen with IPSS measure

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    Cheryl Guttman Krader
    Cheryl Guttman Krader is a contributor to Dermatology Times, Ophthalmology Times, and Urology Times.


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