Quality of Care for Women with Urinary Incontinence in the Veterans Health Administration
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J Gen Intern Med DOI: 10.1007/s11606-020-06196-0 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
medications were restricted to specialists). We defined these actions as the index event. We identified patients who were having new or worsening symptoms requiring clinical assessment or action.
Quality Assessment INTRODUCTION
Urinary incontinence (UI) is a widespread problem affecting 3–17% of community-dwelling and VA women, and has high cost and patient burden.1 Quality deficiencies in primary care for UI have been identified in community settings.2 Whether similar quality concerns are also present in the Veterans Health Administration (VA) is unknown. Our objective was to assess UI care quality for women in VA primary care.
METHODS
For each patient, we assessed care provided in the 18 months prior to, or on the day of, the index event. This timeframe was used in published data for community UI care.2 We excluded patients who received UI medication or specialty, non-VA, or non-PCP urologic care prior to the index event. For each QI, we used abstracted data to determine which episodes of care were eligible for care measured by the QI (the denominator) and, of these, which episodes received the specified care (the numerator). We calculated quality achieved as the percentage of episodes of care that met the action specified in the QI out of the episodes eligible for that QI.
Quality Indicator Identification We identified a comprehensive set of evidence-based quality indicators (QIs) for UI evaluation and management in women,2, 3 then selected the subset applicable to primary care and detailed enough for electronic health record (EHR) measurement. For each QI, we defined the applicable population, inclusion and exclusion parameters, and desired primary care provider (PCP) action for delivering the care specified. We developed an electronic abstraction instrument for data collection.
Study Design and Subjects Using a cross-sectional observational design, we applied these QIs to the care of women receiving primary care 6/2013–9/ 2015 at four VA sites. This study was approved by the VA Greater Los Angeles Healthcare System Institutional Review Board. From all primary care patients at these sites, a trained chart abstractor identified women who received a PCP request for specialty consultation for UI care and/or UI medication prescription (oxybutynin or tolterodine, since other UI Trial Registration ClinicalTrials.gov NCT01918072; VA Greater Los Angeles Healthcare System IRB approved protocol number PCC#2012111579. Prior Presentations This work was presented at The Society of General Internal Medicine Annual Meeting in April 2018. Received June 14, 2020 Accepted August 27, 2020
RESULTS
We identified 538 patients with potential UI referrals or medications. Chart review excluded 408 patients for: UI not being the reason for referral (n = 207); previously treated UI (medication n = 34; other care n = 161
Data Loading...
