Clinical pathways: A roadmap to medical success
I recently wrote about the importance of enhanced recovery after surgery (ERAS) protocols and how they are one tool the average small-town urologist can use to ensure that their results match those of high-volume centers. The concept of protocols (or pathways) to ensure high-quality care is not, however, limited to major cases. Further, with the proper application of practice-specific data analysis and quality assurance, clinical pathways are a rare example in medicine where providing excellent medical care and dramatically improving patients’ lives is not only efficient but financially rewarding.
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Probably the best, though certainly not the only, example of a common urologic condition that can be addressed via a well-defined clinical pathway is overactive bladder (OAB). OAB is an exceptionally common condition, with the Urology Care Foundation stating that over 33 million Americans—30% of men and 40% of women—are actively living with OAB symptoms. Treatment ranges from conservative lifestyle changes to medications to neuromodulatory techniques to onabotulinum toxin (Botox) to aggressive surgery (although the indications for augmentation cystoplasty have certainly decreased over the last few decades).
Until recently, clinicians followed general principles (least invasive to more invasive) as well as their own personal experience when guiding patients on the best treatment options. But in 2014, the AUA in conjunction with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, published a well-researched clinical guideline on the treatment of OAB. This document offered specific guidance on the necessary diagnostic steps and offered help with sequencing the available treatment options.