Impact of surgical training on the performance of proposed quality measures for hysterectomy for pelvic organ prolapse

• Published in: American journal of obstetrics and gynecology 2017-06, Vol.216 (6), p.588.e1-588.e5
• Main Authors: Adams-Piper, Emily R., MD, Guaderrama, Noelani M., MD, Chen, Qiaoling, MS, Whitcomb, Emily L., MD, MAS
• Format: Article
• Language: English
• Subjects: Clinical Competence; Cystoscopy; Fellowships and Scholarships; Female; Gynecologic Surgical Procedures - education; Health Maintenance Organizations; Humans; hysterectomy; Hysterectomy - methods; Hysterectomy - standards; Obstetrics and Gynecology; pelvic organ prolapse; Pelvic Organ Prolapse - surgery; quality measures; Quality of Health Care; Reconstructive Surgical Procedures - education; surgeon volume; training; Treatment Outcome
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2017.02.004

Background Recent healthcare reform has led to increased emphasis on standardized provision of quality care. Use of government- and organization-approved quality measures is 1 way to document quality care. Quality measures, to improve care and aid in reimbursement, are being proposed and vetted in many areas of medicine. Objectives We aimed to assess performance of proposed quality measures that pertain to hysterectomy for pelvic organ prolapse stratified by surgical training. The 4 quality measures that we assessed were (1) the documentation of offering conservative treatment of pelvic organ prolapse, (2) the quantitative assessment of pelvic organ prolapse (Pelvic Organ Prolapse-Quantification or Baden-Walker), (3) the performance of an apical support procedure, and (4) the performance of cystoscopy at time of hysterectomy. Study Design Patients who underwent hysterectomy for pelvic organ prolapse from January 1 to December 31, 2008, within a large healthcare maintenance organization were identified by diagnostic and procedural codes within the electronic medical record. Medical records were reviewed extensively for demographic and clinical data that included the performance of the 4 proposed quality measures and the training background of the primary surgeon (gynecologic generalist, fellowship-trained surgeon in Female Pelvic Medicine and Reconstructive Surgery, and “grandfathered” Female Pelvic Medicine and Reconstructive Surgery). Data were analyzed with the use of descriptive statistics. Inferential statistics with chi-squared tests were used to compare performance rates of quality measures that were stratified by surgical training. Probability values