The AUA Science & Quality Council. J. Stuart Wolf, Jr., M.D., FACS AUA Science &

Transcription

1 The AUA Science & Quality Council J. Stuart Wolf, Jr., M.D., FACS AUA Science &

2 Header. Arial 48. S & Q Council: Components Committees Practice Guidelines Quality Improvement and Patient Safety (QIPS) Data Workgroups EHR Patient Safety 2015 Fellow Program

3 Header. Arial 48. Science & Quality Fellow Open to residents or fellows Learn how the AUA develops and promotes the advancement of evidence-based science A variety of meetings and educational events Application deadline March 19,

4 Header. Arial 48. Practice Guidelines Focused clinical questions of high impact Systematic literature review, data summarization and analysis Actionable statements explicitly linked to strength of evidence 11

5 Header. Arial 48. Practice Guidelines Using Guidelines is not cookbook medicine Optimal individualized medical care is made possible by standard work process With a Guideline (or clinical care pathway, or robust EHR order set, or ) the default care is the best evidence-based practice Thoughtful deviation from pathway individualizes care 12

6 Header. Arial 48. Practice Guidelines: Process 1. Nominate Topic 2. Identify Panel 3. Define Research Questions 4. Conduct Literature Review 5. Extract, Synthesize & Analyze Data 6. Review Evidence Report & Develop Guideline Statements 7. Write Guideline 8. Undergo Peer Review & Revise 9. Obtain Approval & Publish 13

7 Header. Arial 48. Practice Guidelines: Products 39 documents for Urologists 25 Guidelines (will be 30) 5 Best Practice Statements (being revised as Guidelines) 8 other (collaborative works) 14

8 Practice Header. Guidelines: Arial 48. Products 2014/15 Releases Anti-Coagulation / Anti-Platelet Therapy Review Paper Cryptorchidism (AHRQ) Urotrauma Medical Management of Kidney Stones (AHRQ) Overactive Bladder Amendment Castration-Resistant Prostate Cancer Amendment Interstitial Cystitis / Bladder Pain Syndrome Amendment Peyronie s Disease 2016 Releases Surgical Management of Stones Urethral Strictures Non-Muscle Invasive Bladder Cancer (AHRQ) 15

9 Header. Arial 48. Practice Guidelines: Products 2017 Releases Stress Urinary Incontinence Muscle Invasive Bladder Cancer (AHRQ) Localized Prostate Cancer (AHRQ) Renal Mass and Localized Renal Cancer (AHRQ) 2018 (Upcoming) Releases Erectile Dysfunction Testosterone Deficiency Benign Prostatic Hyperplasia (AHRQ) 16

10 Header. Arial 48. Practice Guidelines: Products In Production Neurogenic Lower Urinary Tract Dysfunction Incontinence after Prostate Treatment Recurrent Urinary Tract Infection Male Infertility Testicular Cancer 17

11 Header. Arial 48. Practice Guidelines: Products Other recent products AUA-SAR Consensus Statement on Prostate MRI and MRI Targeted Biopsy in Patients with Prior Negative Biopsy AUA Standard Operating Procedure for MRI of the Prostate Endorsement of 2016 CDC Guideline for Prescribing Opioids for Chronic Pain 18

12 Header. Arial 48. Guideline Dissemination Efforts Executive summary in J Urol Q&A in AUANews and HP Brief Urology and Primary Care APP (over 20,000 downloads) Urology and Primary Care Pocket Guides Webinars Guidelines courses at Annual Meeting Guidelines presentations at Section Meetings Social media outreach 19

13 Header. Arial 48. Practice Guidelines: Uses Daily, practical application Incorporation into EHRs National Quality Measures Certification and re-certification exams Maintenance of certification: ABU s Practice Assessment Protocols 20

14 Quality Header. Improvement Arial 48. and Patient Safety (QIPS) Committed to improving urologic care through the development of quality improvement and patient safety initiatives, by developing products and monitoring federal quality programs and initiatives 21

15 Header. QIPS Products Arial 48. Performance measures Quality initiatives White Papers Quality Improvement Summits Quality Improvement Program Choosing Wisely Initiative 22

16 Header. Arial 48. QIPS Performance Measures Payers rewarding quality care In 2017, CMS launched the Merit-based Incentive Payment System (MIPS) portion of the Quality Payment Program (QPP) of Medicare Access & Chip Reauthorization Act of 2015 (MACRA) To do so, quality must be measured 23

17 Header. Arial 48. QIPS Performance Measures Measures developed from AUA guidelines Tested to ensure validity, reliability Several pathways to acceptance by various federal agencies, MANY hoops! Attempts to ease burden of measure validation for CMS acceptance emeasures, registries, etc. 24

18 Header. Arial 48. QIPS Performance Measures Collaboration and Big Data CoC: Oncology hospital level measures ASCO: advanced prostate cancer measures CMS Spotlight series (Shared Decision Making for PSA screening) Test our own measures in the AQUA Registry Create e-measures 25

19 Header. Arial 48. QIPS Quality Initiatives Monitor Federal and other Programs Physician Compare Hospital Compare Place members on national committees Urology Core Measure Set PQRS (now MIPS) Toolkits and Resources 26

20 Header. Arial 48. QIPS White Papers Processing Flexible Cystoscopes Prostate Biopsy: 2 white papers Catheter-associated UTI Beers Criteria Shared Decision-Making Chronic Urinary Retention 27

21 Header. Arial 48. QIPS White Papers Enhancing Surgical Outcomes Series of 3 documents Specific index patients Preoperative Intraoperative Postoperative settings Will be completed by the 2018 Annual Meeting 28

22 Header. Arial 48. QI Summits Infectious Complications of Prostate Biopsy (1/14) Proceedings published 9/14 Shared Decision Making & CaP Screening (4/16) Proceedings published 3/17 Challenges and Opportunities for Stewardship of Urological Imaging (10/17) Proceedings to be published Opioid Prescribing in Urology Planned for Fall

23 Header. Arial 48. Quality Improvement Program Help practices develop strategic plan for improving quality of care, to increase patient satisfaction and provide better outcomes Measure reporting, QI projects Lean techniques, PDSA cycles (On hold owing to budget concerns) 30

24 Header. Arial 48. Service on National Committees Commission on Cancer Quality Integration Committee Physician Consortium for Performance Improvement (PCPI) Surgical Quality Alliance National Quality Forum American College of Radiology (ACR) Diagnostic Imaging/Interventional Radiology Appropriateness Criteria Committee CMS Technical Expert Panels Stakeholder Forum on Antimicrobial Resistance ACR PCPI Measure Development Panel Hospital Quality Star Ratings Provider Leadership Work Group 31

25 Header. Arial 48. Choosing Wisely 1 st set of 5 statements in nd set of 5 statements in rd set of 5 statements in 2017 Choosing Wisely Champions named in

26 Data Header. Committee Arial 48. AUA Annual Census AUA Data Grant Program AUA Statistical Services AQUA Registry 43

27 Data: Header. AUA Annual Arial 48. Census Launched at 2014 AUA Annual Meeting Collects demographic, educational, geographical and clinical information from urologists, practice managers, trainees, researchers, PAs/NPs/RNs... The State of the Urology Workforce and Practice in the U.S. released annually (first in April 2015) 44

28 Data: Header. AUA Annual Arial 48. Census Public Use Micro Dataset de-identified, weighted census data for research purposes Multi-year Census data files (2014, 2015 and 2016 ) can be linked to conduct longitudinal analyses Numerous conference presentations and journal publications Informs policy decisions and advocacy 45

29 Data: Header. AUA 2017 Arial Census 48. The State of the Urology Workforce and Practice in the U.S. will be released in Spring ,018 respondents, 3,639 (61%) from US Median age of practicing US urologists 55 y/o 12,517 Practicing Urologists in US 10,012 Active Practicing Urologists in US 46

30 Practicing Urologist-to-Population Ratio by State of Primary Practice Location 47

31 Header. Arial 48. Data: AUA Data Grant Program AUA funding of population-based, datadriven research projects, with data and statistical support from AUA Data Department, started in 2015 For 2018, 55 letters of intent received 4 applications selected for funding Up to $25,000 per project 48

32 Header. Arial 48. AUA Statistical Services Consulting for statistical analyses Support for Data Grant projects Fee-for-service for needs of AUA members Staff on-site for AUA projects helping defray AUA expenses Support for abstracts and manuscripts 51

33 Header. Arial 48. Data: AUA Quality Registry 52

34 AUA Header. Quality Arial Registry 48. The first national, specialty-wide, EHR-driven clinical data registry for improving quality of urological care and patient outcome. Initially focused on prostate cancer but now expanding scope. 53

35 AQUA Header. Registry Arial 48. Why? Research on health services, quality of care, patient outcomes, etc. requires highquality and national clinical data Traditional data sources inadequate Claims-based (Medicare, private insurers, etc) Limited clinical: HCUP, NSQIP, etc. Cancer-specific (still limited): SEER, NCDB, etc. 54

36 AQUA Header. Registry Arial 48. Why? Existing clinical registry efforts have excellent track records in research and quality improvement, but manual collection of regional or practice-specific data and difficult to scale CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) MUSIC (Michigan Urologic Surgical Improvement Collaborative) 55

37 AQUA Header. Registry Arial - Mission 48. Collect detailed national process and outcomes data for urologic patients Primary goal Quality improvement Secondary goals Regulatory requirements Next-generation HSR and clinical / outcomes research Policy deliberations and efforts 56

38 AQUA Header. Registry Arial - Initiation 48. Start with prostate cancer Urology s signature disease Initial plan to enroll 100 urology practices and access all men with newly diagnosed prostate cancer Track diagnostics, staging, 1º and 2º treatment, process measures Track outcomes - including PROs 57

39 AQUA Header. Registry Arial - Principles 48. Software (FIGMD) extracts data from EHRs Data owned by practices and AUA Practice-level data shared only with individual practice and practice-agreed payers such as CMS, benchmarked against the aggregate data No practice will see any other individual practice s data. 58

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48 AQUA Registry: Header. Arial January practices, includes 2,772 Urology Care Providers Submitted data to CMS for 215 providers in 2017 (for 2016 reporting) Received interest from 56 practices for 2017 MIPS reporting period A combination of private and academic practices from 47 states, Puerto Rico, US Virgin Islands and DC More than 3.3 million patients with 11.5 million patient encounters 67

49 Header. Arial 48. AQUA Providers Distribution 68

50 Time to Full Production By Year Year Signed Average Std. Dev

51 2018 QCDR Measures Non-QPP Measures (Existing): Prostate Cancer BPH SUI Cryptorchidism Hypogonadism Stones Bladder Cancer 71

52 2018 QCDR Measures Non-QPP Measures (New for 2018): Advanced Prostate Cancer Male Sexual Health Azoospermia Obstructive / Non-obstructive Vasectomy 72

53 Summary: Header. What Arial 48. S & Q Council does for you Your AUA dues at work! Practice guidance Measure development Assistance with patient safety and quality improvement AUA Census and AQUA Registry stuart.wolf@austin.utexas.edu 73

54 AUA Guidelines App Apple App Store Google Play 74