title: Urologist compliance with AUA best practice guidelines for benign prostatic hyperplasia in Medicare population.
abstract: OBJECTIVE
  To improve benign prostatic hyperplasia (BPH) care, the American Urological Association created the best practice guidelines for BPH management. We evaluated the trends in use of BPH-related evaluative tests and the extent to which urologists comply with the guidelines for these evaluative tests.
  
  
  METHODS
  From a 5% random sample of Medicare claims from 1999 to 2007, we created a cohort of 10,248 patients with new visits for BPH to 748 urologists. The trends in use of BPH-related testing were determined. After classifying urologists by compliance with the best practice guidelines, the models were fit to determine the differences in the use of BPH-related testing among urologists. Additional models were used to define the extent to which individual BPH-related tests influenced guideline compliance.
  
  
  RESULTS
  The use of most BPH testing increased with time (P<.001) except for prostate-specific antigen (declined; P<.001) and ultrasonography (P=.416). Northeastern and Midwestern urologists were more likely to be in the lowest compliance group compared with Southern and Western urologists (29%, 27%, 13%, and 19%, respectively; P=.01). The testing associated with high guideline compliance included urinalysis and prostate-specific antigen measurement (P<.01 for both). Prostate ultrasonography (P=.03), cystoscopy (P<.01), uroflow (P<.01), and postvoid residual urine volume determination (P=.02) were associated with low guideline compliance. Urodynamics, postvoid residual urine volume, cytology, serum creatinine, and upper tract imaging were not strongly associated with guideline compliance.
  
  
  CONCLUSIONS
  Despite the American Urological Association guidelines for BPH care, wide variations in the evaluation and treatment were seen. Improving guideline adherence and reducing variation could improve BPH care quality.
authors: Division of Urology Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. stropes@wudosis.wustl.edu
authors: Seth A
authors: SA
authors: Strope
authors: Sean P
authors: SP
authors: Elliott
authors: Christopher S
authors: CS
authors: Saigal
authors: Alex
authors: A
authors: Smith
authors: Timothy J
authors: TJ
authors: Wilt
authors: John T
authors: JT
authors: Wei
references: J Urol. 2006 May;175(5):1830-5; discussion 1835
references: 16600772
references: J Urol. 2006 Mar;175(3 Pt 1):1023-7
references: 16469610
references: N Engl J Med. 2001 Jul 12;345(2):99-106
references: 11450679
references: Med Care. 2009 Feb;47(2):208-16
references: 19169122
references: Urology. 2011 Mar;77(3):535-40
references: 21256570
references: JAMA. 2009 Jan 14;301(2):215-7
references: 19141771
references: Clin Pract Guidel Quick Ref Guide Clin. 1994 Feb;(8):1-17
references: 7507389
references: J Urol. 2008 May;179(5 Suppl):S75-80
references: 18405761
references: Am J Med Qual. 2007 May-Jun;22(3):170-6
references: 17485558
references: Health Aff (Millwood). 2009 Sep-Oct;28(5):1438-47
references: 19738261
references: J Urol. 2009 Nov;182(5):2410-4
references: 19765742
references: J Am Pharm Assoc (2003). 2010 Jul-Aug;50(4):496-507
references: 20621868
references: JAMA. 2009 Dec 9;302(22):2485-6
references: 19996408
references: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references: 12187163
references: Eur Urol. 2004 Nov;46(5):547-54
references: 15474261
references: JAMA. 2009 Feb 25;301(8):868-9
references: 19244197
references: JAMA. 1999 Oct 20;282(15):1458-65
references: 10535437
references: JAMA. 2009 Feb 25;301(8):831-41
references: 19244190
references: Med Care. 2010 Aug;48(8):733-8
references: 20613660
references: Health Serv Res. 1990 Dec;25(5):709-16
references: 1701420
references: Ann Epidemiol. 2007 Aug;17(8):584-90
references: 17531502