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Urology ; 153: 139-146, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33482125

RESUMO

OBJECTIVE: To determine the effectiveness of 2 different continuous quality improvement interventions in an integrated community urology practice. We specifically assessed the impact of audited physician feedback on improving physicians' adoption of active surveillance for low-risk prostate cancer (CaP) and adherence to a prostate biopsy time-out intervention. MATERIALS AND METHODS: The electronic medical records of Genesis Healthcare Partners were analyzed between August 24, 2011 and September 30, 2020 to evaluate the performance of 2 quality interventions: audited physician feedback to improve active surveillance adoption in low-risk CaP patients, and audited physician feedback to promote adherence to an electronic medical records embedded prostate biopsy time-out template. Physician and Genesis Healthcare Partners group adherence to each quality initiative was compared before and after each intervention type using ANOVA testing. RESULTS: For active surveillance, we consistently saw an increase in active surveillance adoption for low risk CaP patients in association with continuous audited feedback (P < .001). Adherence to the prostate biopsy time-out template improved when audited feedback was provided (P < .001). CONCLUSION: The implementation of clinical guidelines into routine clinical practice remains challenging and poses an obstacle to the improvement of United States healthcare quality. Continuous quality improvement should be a dynamic process, and in our experience, audited feedback coupled with education is most effective.


Assuntos
Biópsia , Padrões de Prática Médica/normas , Neoplasias da Próstata , Melhoria de Qualidade/organização & administração , Urologia , Conduta Expectante , Biópsia/métodos , Biópsia/normas , Auditoria Clínica/estatística & dados numéricos , Serviços de Saúde Comunitária/normas , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Fidelidade a Diretrizes , Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Medição de Risco , Estados Unidos/epidemiologia , Urologia/métodos , Urologia/organização & administração , Urologia/normas , Conduta Expectante/métodos , Conduta Expectante/normas
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