Hood H M, Burgess P A, Holtgrewe H L, Fleming B, Mebust W, Connolly R P
Alabama Quality Assurance Foundation, Birmingham, USA.
J Urol. 1997 Oct;158(4):1417-21.
We determined adherence rates to guideline recommendations for the diagnosis and treatment of benign prostatic hyperplasia published and distributed by the Agency for Health Care Policy and Research in 1994.
Measures of care were developed based upon Agency for Health Care Policy and Research guideline recommendations approved by the Health Care Financing Administration and the American Urological Association (AUA). A random 4-state sample of 2,000 inpatient records with a principal diagnosis of hyperplasia of the prostate (ICD-9-CM code 600) and principal procedure code of 60.2 was selected by the Health Care Financing Administration and abstractions were performed. We assessed reliability and validity and determined results for each of the following measures of care: 1) documentation of indications for a transurethral resection of the prostate; 2) documentation of appropriate preoperative assessment; 3) documentation of indications for an inpatient excretory urogram (IVP) and/or sonogram when the procedures were performed and 4) documentation of surgical time and grams of tissue removed. Adherence rates for all measures of care were determined.
Of the 4-state sample of inpatient cases 1,828 cases met entry criteria for the study. Of the cases 93% had at least 1 symptom and/or score, and/or an anatomical abnormality documented before surgery. An AUA score was documented in the inpatient medical record in 7.5% of the cases. Recommendations for preoperative evaluation included urinalysis, a digital rectal exam and determination of preoperative creatinine. All of these were documented in 475 (26%) cases. Of the 1,828 cases 216 (12%) had an IVP or sonogram performed in the inpatient setting. In 36% indications were documented when sonograms were performed; 74% had documented indications when IVPs were performed. Excluding laser transurethral resections of the prostate, surgical time and tissue amounts were documented and recorded in 1,424 transurethral resections of the prostate cases (91%).
Adherence to selected Agency for Health Care Policy and Research guideline recommendations is documented infrequently in the medical record.
我们确定了对1994年医疗保健政策和研究机构发布并分发的良性前列腺增生诊断和治疗指南建议的依从率。
根据经医疗保健财务管理局和美国泌尿外科学会（AUA）批准的医疗保健政策和研究机构指南建议制定护理措施。医疗保健财务管理局从四个州随机抽取了2000份住院病历样本，主要诊断为前列腺增生（ICD-9-CM编码600），主要手术编码为60.2，并进行了摘要提取。我们评估了可靠性和有效性，并确定了以下每项护理措施的结果：1）经尿道前列腺切除术指征的记录；2）适当术前评估的记录；3）进行住院排泄性尿路造影（IVP）和/或超声检查时指征的记录，以及4）手术时间和切除组织克数的记录。确定了所有护理措施的依从率。
在四个州的住院病例样本中，1828例病例符合研究纳入标准。在这些病例中，93%在手术前至少有1项症状和/或评分，和/或记录有解剖学异常。7.5%的病例在住院病历中有AUA评分记录。术前评估建议包括尿液分析、直肠指检和术前肌酐测定。所有这些在475例（26%）病例中都有记录。在1828例病例中，216例（12%）在住院期间进行了IVP或超声检查。超声检查时，36%有指征记录；IVP检查时，74%有指征记录。排除激光经尿道前列腺切除术，1424例经尿道前列腺切除术病例（91%）记录并记录了手术时间和组织量。
在病历中很少记录对医疗保健政策和研究机构选定指南建议的依从情况。
