title: An observational analysis of provider adherence to AUA guidelines on the management of benign prostatic hyperplasia.
abstract: OBJECTIVE
  We retrospectively evaluated urologist adherence to the AUA guidelines on the management of new patients with benign prostatic hyperplasia related lower urinary tract symptoms in a large university urology group.
  
  
  METHODS
  All first time benign prostatic hyperplasia/lower urinary tract symptom visits to the urology clinic at the Northwestern Medical Faculty Foundation between January 1, 2008 and December 31, 2012 were evaluated using an institutionally managed electronic medical record data repository. Clinical documentation and orders from each encounter were assessed to determine the rate of performance of guideline measures. Approximately 1% of all results were manually reviewed in a validation process designed to determine the reliability of the electronic medical record based system.
  
  
  RESULTS
  A total of 3,494 eligible encounters were evaluated in the final analysis. Provider adherence rates with the 9 measures recommended in the guidelines varied by measure from 53.0% to 92.8%. The rate of performance of 5 not routinely recommended measures was 10.2% or less. Post-void residual and urinary flow measurement were optional measures, and were performed on 68.1% and 4.6% of new encounters respectively. Manual validation revealed the electronic medical record data extraction was concordant with manual review in 96.7% of cases (95% CI 94.8-98.5).
  
  
  CONCLUSIONS
  Using electronic medical record based data extraction techniques, we reliably document a baseline adherence rate with AUA guidelines on the management of benign prostatic hyperplasia. Establishing this benchmark will be important for future investigation into patient outcomes related to guideline adherence and into methods for improving provider adherence.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: g-auffenberg@northwestern.edu.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Auffenberg
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.affiliation: American Urological Association, Linthicum, Maryland.
authors.forename: William
authors.initials: W
authors.lastname: Meeks
authors.affiliation: Division of Urology, Southern Illinois University, Springfield, Illinois.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
mesh_terms: D019468:Disease Management; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000628:therapy*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014572:Urology / Q000592:standards*
keywords: electronic health records; guideline; lower urinary tract symptoms; prostatic hyperplasia