11: Impact of surgical training on performance of proposed quality measures for hysterectomy for pelvic organ prolapse

Abstract

The advent of Physician Quality Measure Reporting has increased the interest of specialty groups in the development of quality measures. Within a large healthcare maintenance organization (HMO), we assessed adherence to proposed quality measures for performance of hysterectomy for pelvic organ prolapse (POP) stratified by surgical training. The four measures were: offering conservative treatment of POP, quantitative assessment of POP (Pelvic Organ Prolapse-Quantification or Baden-Walker), performance of an apical support procedure at time of hysterectomy, and performance of cystoscopy during the procedure. Patients undergoing hysterectomy for POP from January 1-December 31, 2008 were identified by procedural codes within the electronic medical record of a HMO. Half the medical records were subject to extensive review including: demographic and clinical data, surgeon training background (gynecologic generalist, fellowship-trained surgeon in Female Pelvic Medicine and Reconstructive Surgery [FPMRS], “grandfathered” in FPMRS), performance of four proposed quality measures and outcome measures within and beyond 12 months after surgery. Data was analyzed using descriptive statistics. Inferential statistics with chi-squared tests were performed to compare performance rates of quality measures stratified by surgical training. P-values less than 0.05 were considered statistically significant. Six hundred sixty-two relevant surgeries were performed in 2008. Of the 328 patients with complete records (three excluded for missing data), gynecologic generalists performed 140 hysterectomies, fellowship-trained surgeons performed 133, and “grandfathered” surgeons performed 55. Frequencies and percentages for individual measures and cumulative performance based on surgeon type are shown in the Table. Fellowship-trained surgeons had the highest performance rates for each measure and cumulative performance of all measures. “Grandfathered” FPMRS surgeons performed significantly fewer measures than fellowship-trained surgeons and more than gynecologic generalists. Within a large HMO, fellowship-trained FPMRS surgeons were significantly more likely to perform proposed quality measures relating to hysterectomy for POP, compared to those without such training. “Grandfathered” FPMRS surgeons performed measures more frequently than generalists but less than fellowship-trained surgeons. Further study is indicated to correlate with outcome measures.