QUALITY-OF-CARE INDICATORS FOR WOMEN WITH OVERACTIVE BLADDER: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract

INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is highly prevalent in the general population and has a strong impact on all measures of quality of life. Unfortunately, there are identifiable variations in the awareness and implementation of guidelines for the diagnosis and management of OAB. The goal of this study was to conduct a systematic literature review to identify potential indicators of quality of care for women with overactive bladder symptoms. METHODS: We first conducted semi-structured interviews with experts in the field of urinary incontinence in order to identify potential candidate quality-of-care indicators. We then searched MEDLINE and the Cochrane database to identify English-language articles published between 1997 and 2008 that focused on evaluation, diagnosis, and management of overactive bladder in women. We conducted supplementary searches at guidelines.gov to identify national and international clinical practice guidelines for urge incontinence/overactive bladder. Additional articles were obtained by reviewing the references of previously identified articles. We then synthesized the evidence by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification. RESULTS: We used more than 30 combinations of search terms relevant to each quality indicator to identify peer-reviewed articles addressing evaluation, diagnosis, examination, and treatment of overactive bladder. We screened 2,127 titles to find 380 relevant abstracts and reviewed the full articles. We identified 34 quality indicators for OAB management through literature reviews and interviews with leading specialists. These candidate indicators address four general domains of care: evaluation, physical examination, diagnostic work-up and treatment. CONCLUSIONS: While the literature includes moderate to strong evidence regarding behavioral and pharmacologic management of OAB, there is a dearth of high-quality studies that address the appropriate diagnostic evaluation of OAB. Instead, recommendations for the proper evaluation and work-up of OAB derive primarily from general practice guidelines and review articles. Further development of quality-of care indicators will allow for large-scale measurement of the quality of care provided to women with OAB, with the ultimate goal of implementing quality improvement programs.