Login to Access Video or Poster Abstract: MP32-09
Sources of Funding: AUA Data Grant and the Urology Care Foundation Research Scholar Award Program

Introduction

Recent policy changes encourage a transition toward value-based care. In 2014, we implemented value-based care redesign for patients undergoing surgery for uncomplicated BPH. We defined an optimal care pathway using outcomes and cost data, guideline recommendations, and patient input. Our pathway includes TURP or plasma vaporization without preoperative cystoscopy or urodynamics. In this study, we ask whether patients treated under a value-based care pathway experience worse outcomes.

Methods

We reviewed records of men undergoing an episode of BPH care between April 2014 and December 2015. Only those with UCLA HMO, ACO, or those having established PPO primary care at UCLA were included. Men with coexisting complicating urological conditions were excluded. The 5 outcomes examined were 1-year reoperation, 90-day readmission, emergency department visit within 30 days, >3 clinic visits within 30 days, BPH prescription filled >30 days after surgery. Potential confounding variables included age, gland size, diabetes, neurologic disease, and preoperative catheter status. We used multivariable logistic regression to test the effect of surgery type and the use of preoperative invasive testing.

Results

There were 225 men with complete data. Fifty-seven men (23%) had diabetes and 73 (29%) used indwelling or intermittent catheter prior to surgery. TURP or plasma vaporizaton was performed in 187 (74%) patients and 145 (58%) underwent preoperative invasive testing (cystoscopy or urodynamics). Patients receiving preoperative invasive testing were more likely to have >3 clinic visits within 30 days (OR 3.7, p=0.005); analyses entering cystoscopy and urodynamics as individual variables shows this attributable to cystoscopy (OR 3.1, p=0.004). There were no other differences in outcomes among those receiving value-based care. Men with neurologic disease and those undergoing laser vaporization were more likely to fill a BPH medication prescription after surgery (OR 2.8, p=0.009 and OR 2.5, p=0.04, respectively). Men >70 were more likely to visit the emergency department (OR 4.7, p=0.004).

Conclusions

Men with uncomplicated BPH receiving value-based surgical care were more likely to avoid certain negative outcomes. While these data validate our a priori hypothesis, we continue to measure clinical outcomes using near real time data extraction and analysis. Iterative evaluation of processes and outcomes are crucial in implementing value-based care models. A limitation is lack of IPSS data. Further studies may elucidate whether these findings apply in other settings.

Funding

AUA Data Grant and the Urology Care Foundation Research Scholar Award Program