Quality-of-care Indicators for Pelvic Organ Prolapse

Development of an Infrastructure for Quality Assessment

Published in: International Urogynecology Journal, v. 24, no. 12, Dec. 2013, p. 2039-2047

Posted on RAND.org on December 01, 2013

by Jennifer T. Anger, Victoria C S Scott, Krista Kiyosaki, Aqsa A. Khan, Claudia Sevilla, Sarah Connor, Carol P. Roth, Mark Litwin, Neil S. Wenger, Paul G. Shekelle

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INTRODUCTION AND HYPOTHESIS: A paucity of data exists addressing the quality of care provided to women with pelvic organ prolapse (POP). We sought to develop a means of measuring this quality through the development of quality-of-care indicators (QIs). METHODS: QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. The indicators were then presented to a panel of nine experts. Using the RAND Appropriateness Method, we analyzed each indicator's preliminary rankings. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which panelists individually re-rated the indicators. QIs with median scores of at least 7 were considered valid. RESULTS: QIs were developed that addressed screening, diagnosis, work-up, and both nonsurgical and surgical management. Areas of controversy included whether screening should be performed to identify prolapse, whether pessary users should undergo a vaginal examination by a health professional every 6 months versus annually, and whether a colpocleisis should be offered to older women planning to undergo surgery for POP. Fourteen out of 21 potential indicators were rated as valid for pelvic organ prolapse (median score ≥7). CONCLUSION: We developed and rated 14 potential quality indicators for the care of women with POP. Once these QIs are tested for feasibility they can be used on a larger scale to measure and compare the care provided to women with prolapse in different clinical settings.

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