Get access

Development of quality indicators for women with urinary incontinence

Authors

  • Jennifer T. Anger,

    Corresponding author
    1. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
    2. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
    • Correspondence to: Jennifer T. Anger, MD, MPH, Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California

      E-mail: jennifer.anger@cshs.org

    Search for more papers by this author
  • Victoria C.S. Scott,

    1. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
    Search for more papers by this author
  • Krista Kiyosaki,

    1. University of Hawaii Medical School, Honolulu, Hawaii
    Search for more papers by this author
  • Aqsa A. Khan,

    1. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California
    Search for more papers by this author
  • Avivah Weinberg,

    1. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
    Search for more papers by this author
  • Sarah E. Connor,

    1. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
    Search for more papers by this author
  • Carol P. Roth,

    1. Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica, California
    Search for more papers by this author
  • Neil Wenger,

    1. Department of Medicine, Los Angeles, David Geffen School of Medicine, University of California, Los Angeles, California
    Search for more papers by this author
  • Paul Shekelle,

    1. Southern California Evidence-Based Practice Center, RAND Corporation, Santa Monica, California
    2. Department of Medicine, Los Angeles, David Geffen School of Medicine, University of California, Los Angeles, California
    3. Veterans' Administration, Greater West Los Angeles Medical Center, Los Angeles, California
    Search for more papers by this author
  • Mark S. Litwin

    1. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
    2. Health Services, School of Public Health, University of California, Los Angeles, California
    Search for more papers by this author

  • Conflict of interest: none.
  • Heinz Koelbl led the peer-review process as the Associate Editor responsible for the paper.

Abstract

Aims

To develop a means to measure the quality of care provided to women treated for urinary incontinence (UI) through the development of quality-of-care indicators (QIs).

Methods

We performed an extensive literature review to develop a set of potential quality indicators for the management of UI. QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. Nine experts ranked the indicators on a nine-point scale for both validity and feasibility. We analyzed preliminary rankings of each indicator using the RAND Appropriateness Method. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which the indicators were rated a second time individually using the same nine-point scale.

Results

QIs were developed that addressed screening, diagnosis, work-up, and both non-surgical and surgical management. Areas of controversy included whether routine screening for incontinence should be performed, whether urodynamics should be performed before non-surgical management is initiated, and whether cystoscopy should be part of the pre-operative work-up of uncomplicated stress incontinence. Following the expert panel discussion, 27 of 40 potential indicators were determined to be valid for UI with a median score of at least seven on a nine-point scale.

Conclusions

We identified 27 quality indicators for the care of women with UI. Once these QIs are pilot-tested for feasibility, they will be applied on a larger scale to measure the quality of care provided to women with UI in the United States. Neurourol. Urodynam. 32:1058–1063, 2013. © 2013 Wiley Periodicals, Inc.

Get access to the full text of this article

Ancillary