Measuring the quality of care provided to women with pelvic organ prolapse.
Measuring the quality of care provided to women with pelvic organ prolapse.
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DOI：
10.1016/j.ajog.2014.10.1105
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发表时间：
2015-04
影响因子：
9.8
通讯作者：
Anger JT
中科院分区：
文献类型：
--
作者：
Alas AN;Bresee C;Eilber K;Toubi K;Rashid R;Roth C;Shekelle P;Wenger N;Anger JT
对卫生保健提供者的评价越来越多地取决于他们提供的保健质量。我们的目的是评估最近开发的盆腔器官脱垂（POP）质量指标（QIs）的可行性，并确定护理中可能存在的缺陷。一个小组根据评估POP的筛查和诊断、必要的管理和手术的RAND适当性方法对14个QIs进行了排名。使用《国际疾病分类》第九版诊断代码，在医院多专科组中确定诊断为POP的患者后，进行回顾性图表提取。在283例确诊患者中，98%新发阴道隆起的患者进行了盆腔检查。6%的人对POP进行了描述，但没有进行分级，25.1%的人根本没有记录。在使用子宫托的患者中，98%至少每6个月进行一次阴道检查。49%的手术患者术前有完整的POP分期。在接受根尖手术的女性中，只有20%的人有关于不同手术选择的咨询记录，而在因POP接受子宫切除术的女性中，只有48%的人同时有拱顶悬吊。尽管71%的患者有术后应激性尿失禁的风险记录，但只有14.5%的患者有关于补片风险的咨询记录。只有37%的植入补片的患者有1年的随访记录。术中进行膀胱镜检查的有86%的患者接受了膀胱膨出修复或根尖手术。用QIs可以切实地衡量患POP妇女的护理质量。许多地区的护理过程存在缺陷，我们的研究结果可以作为质量改进干预措施的基础。
Health care providers are increasingly being evaluated by the quality of care they provide. Our aim was to assess the feasibility of recently developed quality indicators (QIs) for pelvic organ prolapse (POP) and identify possible deficits in care. A panel ranked 14 QIs based on the RAND appropriateness method assessing screening and diagnosis, pessary management, and surgery for POP. Retrospective chart abstraction was performed after identifying patients with a diagnosis of POP evaluated within a hospital-based multispecialty group using International Classification of Diseases, ninth edition, diagnosis codes. Of 283 patients identified, 98% of those with a new complaint of vaginal bulge had a pelvic examination. The POP was described but not staged in 6% and not documented at all in 25.1%. Among those managed with pessaries, 98% had vaginal examinations at least every 6 months. Forty-nine percent of the patients who had surgery had complete preoperative POP staging. Only 20% of women undergoing apical surgery had documentation of counseling regarding different surgical options, and of the women who underwent a hysterectomy for POP, only 48% had a concomitant vault suspension. Although 71% had documentation about the risk of postoperative stress incontinence, only 14.5% had documented counseling regarding risks of mesh. Only 37% of patients implanted with mesh for POP had documented follow-up at 1 year. An intraoperative cystoscopy was performed in 86% undergoing cystocele repair or apical surgery. The quality of care for women with POP can be feasibly measured with QIs. Processes of care were deficient in many areas, and our findings can serve as a basis for quality improvement interventions.