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遵循 AUA 指南进行 BPH 的检查、医学管理、手术评估和治疗:来自质量改进合作的工作。

Adherence to AUA guidelines for the work-up, medical management, surgical evaluation and treatment of BPH: Work from a quality improvement collaborative.

机构信息

College of Medicine, University of Kentucky, Lexington, Kentucky, USA.

Department of Urology, University of Kentucky, Lexington, Kentucky, USA.

出版信息

Low Urin Tract Symptoms. 2024 Jul;16(4):e12526. doi: 10.1111/luts.12526.

Abstract

INTRODUCTION

Previous studies noted varied adherence to clinical practice guidelines (CPGs), but studies are yet to quantify adherence to American Urological Association BPH guidelines. We studied guideline adherence in the context of a new quality improvement collaborative (QIC).

METHODS

Data were collected as part of a statewide QIC. Medical records for patients undergoing select CPT codes from January 2020 to May 2022 were retrospectively reviewed for adherence to selected BPH guidelines.

RESULTS

Most men were treated with transurethral resection of the prostate. Notably, 53.3% of men completed an IPSS and 52.3% had a urinalysis. 4.7% were counseled on behavioral modifications, 15.0% on medical therapy, and 100% on procedural options. For management, 79.4% were taking alpha-blockers and 59.8% were taking a 5-ARI. For evaluation, 57% had a PVR, 63.6% had prostate size measurement, 37.4% had uroflowmetry, and 12.3% were counseled about treatment failure. Postoperatively, 51.6% completed an IPSS, 57% had a PVR, 6.50% had uroflowmetry, 50.6% stopped their alpha-blocker, and 75.0% stopped their 5-ARI.

CONCLUSIONS

There was adherence to preoperative testing recommendations, but patient counseling was lacking in the initial work-up and preoperative evaluation. We will convey the data to key stakeholders, expand data collection to other institutions, and devise an improvement implementation plan.

摘要

简介

先前的研究指出,临床实践指南(CPG)的遵循情况存在差异,但尚未有研究量化对美国泌尿外科学会(AUA)前列腺增生(BPH)指南的遵循情况。我们在一个新的质量改进合作(QIC)的背景下研究了指南的遵循情况。

方法

数据是作为全州范围的 QIC 的一部分收集的。回顾性审查了 2020 年 1 月至 2022 年 5 月期间接受特定 CPT 代码治疗的患者的医疗记录,以评估其对选定 BPH 指南的遵循情况。

结果

大多数患者接受了经尿道前列腺切除术。值得注意的是,53.3%的患者完成了 IPSS 评分,52.3%的患者进行了尿液分析。4.7%的患者接受了行为改变的咨询,15.0%的患者接受了药物治疗,100%的患者接受了手术选择。在管理方面,79.4%的患者服用了α受体阻滞剂,59.8%的患者服用了 5-α 还原酶抑制剂。在评估方面,57%的患者有前列腺体积测量值,37.4%的患者进行了尿流率检查,12.3%的患者接受了关于治疗失败的咨询。术后,51.6%的患者完成了 IPSS 评分,57%的患者有残余尿量(PVR),6.50%的患者进行了尿流率检查,50.6%的患者停止了服用α受体阻滞剂,75.0%的患者停止了服用 5-α 还原酶抑制剂。

结论

术前检查建议得到了遵循,但在初始检查和术前评估中,患者咨询存在不足。我们将向主要利益相关者传达数据,扩大数据收集范围至其他机构,并制定改进实施计划。

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