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. 2012 Jul;80(1):84-9.
doi: 10.1016/j.urology.2012.03.011. Epub 2012 May 18.

Evaluative care guideline compliance is associated with provision of benign prostatic hyperplasia surgery

Seth A Strope  1 , John T Wei, Alexandria Smith, Timothy J Wilt, Christopher S Saigal, Sean P Elliott; Urologic Diseases in America Project
Affiliations

Evaluative care guideline compliance is associated with provision of benign prostatic hyperplasia surgery

Seth A Strope et al. Urology. 2012 Jul.

Abstract

Objective: To determine the impact of evaluative care guideline compliance on surgical intervention for benign prostatic hyperplasia (BPH).

Methods: From Medicare claims data, we developed a cohort of men new to a urologist with a diagnosis of BPH. We determined urologists' compliance with guideline recommended care (3 months) and their time- and geography-standardized average monthly Medicare expenditures (1 year). At the level of the urologist, we assessed the impact of these measures on the use of surgical therapy within 1 year of the new patient visit.

Results: Of 10 248 patients in the cohort, 675 received surgical intervention (6.7%). Guideline compliance (2% received surgery in highest quintile; 11% lowest quintile) was associated with surgical intervention. The results were robust to adjustment for patient and surgeon factors (Guideline Compliance, odds ratio = 0.09; 95% confidence interval = 0.06-0.15, highest to lowest adherence).

Conclusion: Urologists who tend to follow the AUA best practice guidelines for BPH evaluation perform surgical interventions on their BPH patients less frequently than urologists who do not follow these guidelines.

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Figures

Figure 1
Figure 1. Percentage of Patients Receiving Surgery across the Quintiles of Guideline Compliance
Overall, 6.7% of patients in the study received a surgical intervention. 2% of patients treated by urologists in the highest quintile of guideline compliance received surgery compared to 11% treated by urologists in the lowest quintile.
Figure 2
Figure 2. Adjusted Odds Ratios of Receiving Surgical Therapy by Compliance with Guidelines
The adjusted model incorporates expenditures on evaluative care and guideline compliance and adjusts for patient (age, race, comorbidity, and socioeconomic status) and urologist (type of practice, practice location, and years in practice) factors. Adjustment was made for temporal trends by adding a term for year to the model. Interactions between intensity and guideline adherence were assessed, but were not significant, and were excluded from the final model.
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