Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Urology. 2012 Jul;80(1):84-9. doi: 10.1016/j.urology.2012.03.011. Epub 2012 May 18.
To determine the impact of evaluative care guideline compliance on surgical intervention for benign prostatic hyperplasia (BPH).
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.
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).
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.
确定评估性护理指南遵从性对良性前列腺增生（BPH）手术干预的影响。
我们从医疗保险索赔数据中开发了一组新到泌尿科医生就诊的患有 BPH 的男性队列。我们确定了泌尿科医生对指南推荐护理的遵从性（3 个月）以及他们的时间和地理标准化的平均每月医疗保险支出（1 年）。在泌尿科医生层面，我们评估了这些措施对新患者就诊后 1 年内手术治疗使用的影响。
在队列中的 10248 名患者中，有 675 名接受了手术干预（6.7%）。指南遵从性（2%的患者接受手术治疗，最高五分位数；11%的患者接受手术治疗，最低五分位数）与手术干预相关。结果在调整了患者和外科医生因素后仍然稳健（指南遵从性，比值比=0.09；95%置信区间=0.06-0.15，最高至最低依从性）。
倾向于遵循 AUA 对 BPH 评估的最佳实践指南的泌尿科医生对其 BPH 患者进行手术干预的频率低于不遵循这些指南的泌尿科医生。
