Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points

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Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older men, with a prevalence of 50% by age 60 years and 90% by the ninth decade of life (Medina, Parra, & Moore, 1999). The enlarged gland had been proposed to contribute to the overall lower urinary tract symptoms (LUTS) complex (McVary et al., 2014). Although LUTS secondary to BPH is not often a life-threatening condition, the impact of LUTS/BPH on quality of life can be significant (Wei, Calhoun, & Jacobsen, 2005). The American Urological Association Symptom Index (AUA-SI) and the International Prostate Symptom Score (IPSS) were developed to measure outcomes in studies of different treatments for BPH (Wuerstle et al., 2011). The IPSS uses the same questions as the AUA-SI, but also adds a disease-specific quality of life question (OLeary, 2005). The IPSS was adopted in 1993 by the World Health Organization. It is a reproducible, validated index designed to determine disease severity and response to therapy (D’Silva, Dahm, & Wong, 2014). It includes 3 storage symptom questions (frequency, nocturia, urgency) and four voiding symptoms (feeling of incomplete emptying, intermittency, straining, and a weak stream) as well as a Bother question: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? A three-point improvement in the score is considered meaningful (McVary et al., 2014).

The symptoms of BPH are lower urinary tract symptoms (LUTS). There are other disorders with similar symptoms that need to be excluded. History, physical examination, and testing are required prior to a diagnosis of BPH. IPSS by itself is not a reliable diagnostic tool for LUTS suggestive of BPH, but serves as a quantitative measure of LUTS after the diagnosis is established (D’Silva, Dahm, & Wong, 2014). Medical and surgical interventions for BPH recommend a follow up IPSS evaluation to determine effectiveness of treatment. IPSS should be evaluated at the time of diagnosis and after definitive treatment.

A meaningful improvement is a negative 3-point change in the urinary symptom score. The quality improves when a higher proportion of people meet the meaningful improvement definition.

Reference Type: CITATION

Reference Text: 'D'Silva, K. A., Dahm, P., & Wong, C. L. (2014). Does this man with lower urinary tract symptoms have bladder outlet obstruction? The Rational Clinical Examination: A systematic review. Journal of the American Medical Association, 312(5), 535-542. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/25096693'

Reference Type: CITATION

Reference Text: 'McVary, K. T., Roehrborn, C. G., Avins, A. L., et al. (2014). Management of benign prostatic hyperplasia. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/21420124/'

Reference Type: CITATION

Reference Text: 'Medina, J. J., Parra, R. O., & Moore, R. G. (1999). Benign prostatic hyperplasia (the aging prostate). Medical Clinics of North America, 83(5), 1213-1229. Retrieved from
http://www.sciencedirect.com/science/article/pii/S0025712505701590'

Reference Type: CITATION

Reference Text: 'O’Leary, M. P. (2005). Validity of the Bother Score in the evaluation and treatment of symptomatic benign prostatic hyperplasia. Reviews in Urology, 7(1), 1-10. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477553/'

Reference Type: CITATION

Reference Text: 'Wei, J., Calhoun, E., & Jacobsen, S. (2005). Urologic diseases in America project: Benign prostatic hyperplasia. Journal of Urology, 173(4), 1256-1261. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/15758764'

Reference Type: CITATION

Reference Text: 'Wuerstle, M. C., Van Den Eeden, S. K., Poon, K. T., et al. (2011). Contribution of common medications to lower urinary tract symptoms in men. Archives of Internal Medicine, 171(18), 1680-1682.
Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21987200'

Clinically significant Benign Prostatic Hyperplasia (BPH) is BPH with lower urinary tract symptoms (LUTS).
IPSS - International Prostate Symptom Score
AUA-SI - American Urological Association-Symptom Index
QOL - Quality of Life score

The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score.

The patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts. 

Hospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions.

This eCQM is a patient-based measure.

Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.

This version of the eCQM uses QDM version 5.6.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Male patients with an initial diagnosis of benign prostatic hyperplasia 6 months prior to, or during the measurement period, and a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit during the measurement period

Equals Initial Population

Patients with urinary retention that starts within 1 year of initial BPH diagnosis.
Patients with an initial BPH diagnosis that starts during, or within 30 days of hospitalization.
Patients with a diagnosis of morbid obesity, or with a BMI Exam >=40 before the follow up urinary symptom score.

Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period

Not Applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity and sex