Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California.
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California.
J Urol. 2016 Oct;196(4):1196-200. doi: 10.1016/j.juro.2016.05.005. Epub 2016 May 7.
Our aim was to test the feasibility of a set of quality of care indicators for urinary incontinence and at the same time measure the care provided to women with urinary incontinence in 2 clinical settings.
This was a pilot test of a set of quality of care indicators. A total of 20 quality of care indicators were previously developed using the RAND Appropriateness Method. These quality of care indicators were used to measure care received for 137 women with a urinary incontinence diagnosis in a 120-physician hospital based multispecialty medical group. We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of ACOVE (Assessing Care of Vulnerable Elders Project). As a post-hoc secondary analysis, the 2 populations were compared with respect to quality, as measured by compliance with the quality of care indicators.
In the ACOVE population, 37.7% of patients with urinary incontinence underwent a pelvic examination vs 97.8% in the multispecialty medical group. Only 15.6% of cases in the multispecialty medical group and 14.2% in ACOVE (p = 0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index of greater than 25 kg/m(2) were counseled about weight loss in either population (20.9% multispecialty medical group vs 26.1% ACOVE, p = 0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking and only 9.3% of eligible cases (multispecialty medical group only) had documentation of the risks of mesh.
Quality of care indicators are a feasible means to measure the care provided to women with urinary incontinence. Care varied by population studied and yet deficiencies in care were prevalent in both patient populations studied.
我们旨在测试一组用于尿失禁的护理质量指标的可行性，同时测量 2 种临床环境下尿失禁女性的护理情况。
这是一组护理质量指标的初步测试。使用 RAND 适宜性方法预先制定了总共 20 项护理质量指标。这些护理质量指标用于测量在一个拥有 120 名医师的多专科医疗集团中，对 137 名尿失禁诊断患者的护理情况。我们还从加利福尼亚州南部的初级保健办公室提取了 146 份患者记录。这些图表之前是作为 ACOVE（评估弱势老年人护理项目）的一部分使用的。作为事后的二次分析，根据对护理质量指标的依从性，将这 2 个群体进行了质量比较。
在 ACOVE 人群中，37.7%的尿失禁患者接受了盆腔检查，而多专科医疗组中这一比例为 97.8%。只有 15.6%的多专科医疗组患者和 14.2%的 ACOVE 患者（p=0.86）有记录表明提供了盆底肌锻炼。在这两个群体中，BMI 大于 25kg/m²的女性中，相对较少的人接受了减肥方面的咨询（多专科医疗组为 20.9%，ACOVE 为 26.1%，p=0.76）。在接受吊带手术的女性中，缺乏关于风险的咨询记录，仅有 9.3%的合格病例（仅多专科医疗组）有记录说明网片的风险。
护理质量指标是测量尿失禁女性护理情况的可行方法。护理情况因研究人群而异，但在研究的两个患者群体中，护理不足的情况都很普遍。
