title: Measuring the quality of care provided to women with pelvic organ prolapse.
abstract: OBJECTIVE
  Health care providers are increasingly being evaluated by the quality of care they provide. Our aim was to assess the feasibility of recently developed quality indicators (QIs) for pelvic organ prolapse (POP) and identify possible deficits in care.
  
  
  METHODS
  A panel ranked 14 QIs based on the RAND appropriateness method assessing screening and diagnosis, pessary management, and surgery for POP. Retrospective chart abstraction was performed after identifying patients with a diagnosis of POP evaluated within a hospital-based multispecialty group using International Classification of Diseases, ninth edition, diagnosis codes.
  
  
  RESULTS
  Of 283 patients identified, 98% of those with a new complaint of vaginal bulge had a pelvic examination. The POP was described but not staged in 6% and not documented at all in 25.1%. Among those managed with pessaries, 98% had vaginal examinations at least every 6 months. Forty-nine percent of the patients who had surgery had complete preoperative POP staging. Only 20% of women undergoing apical surgery had documentation of counseling regarding different surgical options, and of the women who underwent a hysterectomy for POP, only 48% had a concomitant vault suspension. Although 71% had documentation about the risk of postoperative stress incontinence, only 14.5% had documented counseling regarding risks of mesh. Only 37% of patients implanted with mesh for POP had documented follow-up at 1 year. An intraoperative cystoscopy was performed in 86% undergoing cystocele repair or apical surgery.
  
  
  CONCLUSIONS
  The quality of care for women with POP can be feasibly measured with QIs. Processes of care were deficient in many areas, and our findings can serve as a basis for quality improvement interventions.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, Weston, FL.
authors.forename: Alexandriah N
authors.initials: AN
authors.lastname: Alas
authors.affiliation: Department of Biostatistics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bresee
authors.affiliation: Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Karyn
authors.initials: K
authors.lastname: Eilber
authors.affiliation: Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Karen
authors.initials: K
authors.lastname: Toubi
authors.affiliation: Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Rezoana
authors.initials: R
authors.lastname: Rashid
authors.affiliation: Southern California Evidence-Based Practice Center, RAND Corporation, Los Angeles, CA.
authors.forename: Carol
authors.initials: C
authors.lastname: Roth
authors.affiliation: Southern California Evidence-Based Practice Center, RAND Corporation, Los Angeles, CA; Department of Internal Medicine, Veterans Affairs Greater West Los Angeles Medical Center, Los Angeles, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Shekelle
authors.affiliation: Southern California Evidence-Based Practice Center, RAND Corporation, Los Angeles, CA; Department of Internal Medicine David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Neil
authors.initials: N
authors.lastname: Wenger
authors.affiliation: Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: angerj@cshs.org.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
mesh_terms: D002140:California; D003697:Delphi Technique; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000628:therapy*; D010570:Pessaries / Q000706:statistics & numerical data; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000706:statistics & numerical data
keywords: RAND appropriateness method; modified Delphi method; pelvic organ prolapse; quality improvement