In July, the AUA, working with the American College of Obstetricians and Gynecologists (ACOG), submitted five proposed measures pertaining to stress urinary incontinence (SUI) to the National Quality Forum (NQF) as part of Stage 1 of its new endorsement pilot process.
The topic was selected because SUI has a significant impact on quality of life for many women and may lead to limitations and morbidities, especially in those who do not seek treatment due to lack of awareness or stigma. Although estimates of prevalence vary widely due to inconsistencies in the definitions of SUI and differences in populations studied, a large meta-analysis reported an estimated prevalence for urinary incontinence of 30 percent in women aged 30 to 60 years, with approximately half of the cases attributed to SUI-type leakage.
With millions of women potentially affected by SUI, there is a substantial financial burden not only on the healthcare system to manage and treat the condition, but also on the individual who is responsible for routine care costs (e.g. pads, laundry, dry cleaning, etc.). The estimated annual direct cost of SUI treatment in the United States exceeds $13 billion. Furthermore, 29 percent of women with SUI describe their symptoms as moderately to extremely bothersome, reflecting the overall emotional and social burden associated with the condition.
Additionally, studies documenting regional and race-related differences in practice patterns suggest a significant opportunity to improve counseling of patients regarding appropriate treatment and to improve surgical outcomes via this set of measures.
The SUI measures project officially began in June 2010; under the American Medical Association Physician Consortium for Performance Improvement (PCPI) Independent Measure Development Process, a multi-disciplinary workgroup was convened to develop a set of quality measures focused on achieving better outcomes for female patients with SUI. The workgroup reviewed a slate of measure possibilities and winnowed it down to five process measure concepts. Since that time, the workgroup, together with AUA staff and representatives from PCPI, have been refining the measures to create the proposed set, which aims to ensure that effective treatment for SUI is appropriately applied and that the success of such treatment is ensured. These measures are designed for practitioner-level quality improvement and are appropriate for the ambulatory/office-based setting. These measures are based on guidelines from the American Urological Association, American College of Obstetricians and Gynecologists, European Association of Urology, and National Institute for Health and Clinical Excellence.
While we cannot share the measure specifications at this time since they are technically still under development, we wanted to update our members on the status of the project. An NQF Steering Committee meeting is planned for this fall — we will keep you apprised of more information as it becomes available.