2075 EVALUATING THE QUALITY OF URINARY INCONTINENCE AND PROLAPSE TREATMENT (EQUIPT) STUDY: QUALITY INDICATOR DEVELOPMENT FOR PELVIC ORGAN PROLAPSE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20112075 EVALUATING THE QUALITY OF URINARY INCONTINENCE AND PROLAPSE TREATMENT (EQUIPT) STUDY: QUALITY INDICATOR DEVELOPMENT FOR PELVIC ORGAN PROLAPSE Aqsa Khan, Krista Kiyosaki, Victoria Scott, Claudia Sevilla, Sarah Connor, Carol Roth, Mark Litwin, Larissa Rodriguez, Neil Wenger, Paul Shekelle, and Jennifer Anger Aqsa KhanAqsa Khan Los Angeles, CA More articles by this author , Krista KiyosakiKrista Kiyosaki Honolulu, HI More articles by this author , Victoria ScottVictoria Scott Los Angeles, CA More articles by this author , Claudia SevillaClaudia Sevilla Los Angeles, CA More articles by this author , Sarah ConnorSarah Connor Los Angeles, CA More articles by this author , Carol RothCarol Roth Los Angeles, CA More articles by this author , Mark LitwinMark Litwin Los Angeles, CA More articles by this author , Larissa RodriguezLarissa Rodriguez Los Angeles, CA More articles by this author , Neil WengerNeil Wenger Los Angeles, CA More articles by this author , Paul ShekellePaul Shekelle Los Angeles, CA More articles by this author , and Jennifer AngerJennifer Anger Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2370AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the ultimate goal of measuring the quality-of-care provided to women with pelvic floor disorders (PFDs), we sought to develop and rate a set of quality-of-care indicators (QIs) for the work-up and management of pelvic organ prolapse (POP). METHODS An extensive literature review was performed to develop a set of 19 potential quality indicators for the management of pelvic organ prolapse. QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. The indicators were then presented to a panel of nine experts who were asked to rate the indicators on a nine-point scale for both validity and feasibility. Using the RAND Appropriateness Method, analysis was performed on preliminary rankings of each indicator. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which the indicators were rated a second time individually using the same nine-point scale. Based on the post-discussion ratings, quality indicators that received a median score of greater than or equal to seven were passed. RESULTS Quality indicators were developed that addressed screening, diagnosis, work-up, and both nonsurgical and surgical management. Areas of controversy included whether screening should be performed to identify prolapse, whether pessary users should undergo a vaginal exam by a health professional every six months versus annually, and whether a colpocleisis should routinely be offered to older women planning to undergo surgery for POP. Controversy also centered on whether a prophylactic sling should be offered at the time of prolapse surgery. Following the expert panel discussion, 12 of 18 potential indicators were determined to be valid for pelvic organ prolapse with a median score of 7 or greater. CONCLUSIONS We developed and rated twelve potential quality indicators for the care of women with POP. Once these QIs are tested for feasibility they will be applied on a national level to measure the quality of care provided to women with POP in the United States. Quality Indicators in the Management of Pelvic Organ Prolapse SCREENING/DIAGNOSIS: Any woman who complains of a new or worsening vaginal bulge or protrusion should be examined for POP. TREATMENT/MANAGEMENT WITH A PESSARY: A woman who has symptoms of prolapse should be offered a pessary. Any woman who is being managed with a pessary should have a vaginal exam every 6 months. SURGICAL MANAGEMENT: A woman who has asymptomatic POP of stage 1 or less should not be offered surgical intervention. A woman who chooses surgical intervention of POP should be staged by pre-op pelvic exam and prolapse components should be documented. A woman with symptomatic apical prolapse who undergoes surgery should be counseled on the risks and benefits of abdominal and vaginal approaches. A woman who undergoes hysterectomy for POP should undergo a vault suspension procedure. A woman who elects to undergo an abdominal sacrocolpopexy (either open, laparoscopic, or robotic), regardless of the results of pre-operative stress testing with prolapse reduction, should be offered or discuss a Burch or other continence procedure Women undergoing surgical repair of anterior/apical POP should becounseled about the risk of post-op SUI. When a woman undergoes surgery for anterior and/or apical vaginal prolapse, intra-operative cystoscopy to evaluate for bladder and ureteral integrity should be performed. A woman over age 65 with advanced POP (stage 3 or greater) who plans to undergo surgical treatment of prolapse and no longer wishes to engage in sexual activity should have been offered a colpocleisis. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e830-e831 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aqsa Khan Los Angeles, CA More articles by this author Krista Kiyosaki Honolulu, HI More articles by this author Victoria Scott Los Angeles, CA More articles by this author Claudia Sevilla Los Angeles, CA More articles by this author Sarah Connor Los Angeles, CA More articles by this author Carol Roth Los Angeles, CA More articles by this author Mark Litwin Los Angeles, CA More articles by this author Larissa Rodriguez Los Angeles, CA More articles by this author Neil Wenger Los Angeles, CA More articles by this author Paul Shekelle Los Angeles, CA More articles by this author Jennifer Anger Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...