Abstract: PD32-10
Sources of Funding: AUA Data Grant and Urology Care Foundation Research Scholar Award Program

Introduction

For provider organizations transitioning to value-based care models, physician engagement and support in testing new models is critical. Little is known about how to optimally engage physicians in these activities, which simultaneously target cost and quality of care. To test whether individualized physician feedback would improve adherence to a value-based care pathway, we gave quarterly surgeon-specific feedback on outcomes, practice patterns, and cost data. We hypothesized that value-based care pathway (VBCP) adherence would modestly increase.

Methods

We studied men undergoing surgery for uncomplicated BPH at our institution between March 1, 2013 and December 17, 2015. In April 2014, we defined and introduced a value-based care pathway (VBCP) for BPH to surgeons in our department. Physicians confidentially received their outcomes, cost, and practice pattern data compared to de-identified colleague data in a quarterly email from the Department leadership. Rates of pathway adherence were measured pre- and post-intervention. We used t-tests for physician-level evaluation using the physician as the unit of analysis. A multilevel logistic regression model was fit for patient-level analyses using random intercepts for the physician.

Results

There were 225 patients with complete data available representing 18 treating urologists. Two value-based pathways were used for analysis. The AUA recommended pathway requires PSA testing when indicated, urinalysis, and post-void residual (PVR) measurement, but is silent on surgery type or preoperative invasive testing. The VBCP requires in addition that cystoscopy or urodynamics are not performed preoperatively and bipolar transurethral resection/vaporization is the operation of choice. In the physician-level analysis, AUA recommended compliance increased from 1.8% to 9.2% (p=0.02) while increasing from 3.5% to 11.8% (p=0.03) in the patient-level analysis. VBCP compliance increased from 0% to 5% in physician-level (p=0.002) and patient-level (p=0.03) analyses.

Conclusions

Surgeon-specific data feedback, in isolation, very modestly drove physician behavior toward value-based care models for BPH surgery. VBCP adherence remained low throughout the study period. Further studies are needed to better understand whether physician-identified reporting of data or financial incentives might facilitate the transition to value-based care in urologic surgery.

Funding

AUA Data Grant and Urology Care Foundation Research Scholar Award Program