ADHERENCE TO AGENCY FOR HEALTH-CARE POLICY AND RESEARCH GUIDELINES FOR BENIGN PROSTATIC HYPERPLASIA

Purpose: We determined adherence rates to guideline recommendations fo r the diagnosis and treatment of benign prostatic hyperplasia publishe d and distributed by the Agency for Health Care Policy and Research in 1994. Materials and Methods: Measures of care were developed based up on Agency for Health Care Policy and Research guideline recommendation s approved by the Health Care Financing Administration and the America n Urological Association (AUA). A random 4-state sample of 2,000 inpat ient 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 per formed. We assessed reliability and validity and determined results fo r each of the following measures of care: 1) documentation of indicati ons 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 proc edures were performed and 4) documentation of surgical time and grams of tissue removed. Adherence rates for all measures of care were deter mined. Results: Of the 4-state sample of inpatient cases 1,828 cases m et entry criteria for the study. Of the cases 93% had at least 1 sympt om and/or score, and/or an anatomical abnormality documented before su rgery. An AUA score was documented in the inpatient medical record in 7.5% of the cases. Recommendations for preoperative evaluation include d 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 perfor med; 74% had documented indications when IVPs were performed. Excludin g laser transurethral resections of the prostate, surgical time and ti ssue amounts were documented and recorded in 1,424 transurethral resec tions of the prostate cases (91%). Conclusions: Adherence to selected Agency for Health Care Policy and Research guideline recommendations i s documented infrequently in the medical record.