A Data-Based Practice Model For Pessary Treatment Of Pelvic Organ Prolapse: A Quality Improvement Project

Abstract

Background: Pelvic organ prolapse (POP) can be treated surgically or, more conservatively, with use of a pessary. Objective: To determine if the population of women treated for POP with the use of a pessary in one Nurse Practitioner's (NP) practice demonstrated health outcomes as better, same, or needing improvement through use of a data-based practice model from encounter data extracted from the electronic health record (EHR).Design: The project design was a quality improvement (QI) project, descriptive in nature. One Plan Do Study Act (PDSA) cycle was conducted for this QI project. Setting: NP managed specialty clinic in urban Southwestern Arizona that provides services to women with POP. Patients: Ten randomly selected women who had been treated conservatively for POP with use of a pessary were identified as two subpopulations and evaluated: women who received professional management of the pessary and women who were patient managed. Intervention: The intervention was the development of a data-based practice model, using patient profile data elements derived from the documented EHR encounters of the 10 women. Measurements: Twelve scales were developed to evaluate the patient profile data elements, generating numeric scores for each encounter. Two Decision Rules were then used to evaluate numeric scores by encounter, creating primary and secondary health outcomes. Limitations: Two limitations were identified. The QI project was limited by the small sample size of 10 patients. This is however, true to PDSA guidelines that recommend small scale cycles. The data were limited as only documented data were used. Conclusions: In general, the expected outcome was the outcome observed; the provider was unaware of any women in this QI Project who were not successfully treated with use of a pessary for treatment of POP. The value of this data-based practice model is that outcomes can be aggregated across populations rather than relying on recall of individual outcomes and therefore has potential to be used regularly and systematically as a quality feedback loop, as well as on a larger scale in future PDSA cycles to determine other outcomes beyond a single provider in this or other similar clinical populations.