The Long Road to Healthcare Quality Standardization and Optimization in Urology.

[OBJECTIVE] To evaluate a historical perspective of US healthcare quality evolution over the past 100 years, consider pioneers and seminal events that have framed current US healthcare quality in general and specifically in urology.

[METHODS] A review of influential physicians and organizations who influenced the evolution of quality measurement and improvement was performed. Analysis of urological care examples was performed to identify successes and deficiencies including current Medicare quality measure reporting by urologists.

[RESULTS] Dr Ernest Codman laid the groundwork for modern medical quality improvement, Dr Avedis Donabedian defined structure, process, and outcome as being central to quality measurement and improvement providing a foundational framework applicable to all medical specialties including urology, and Dr David Sackett promoted the concept of "evidence-based medicine" (EBM). Grading the quality of scientific evidence, defining clinical practice guidelines and the multidisciplinary field of implementation science have positively impacted healthcare quality. Recent CMS approval of a urology specific Merit-based Incentive Payment System (MIPS) Value Pathway (MVP) is a step toward focused sets of clinical measures and activities that are more meaningful to a clinician's specialty practice. Analysis of recent MIPS "quality measure" reporting indicates that the majority of urologists report on cross cutting measures (blood pressure, smoking cessation, obesity) rather than more urology relevant quality measures such as active surveillance for low-risk prostate cancer.

[CONCLUSION] Healthcare quality principles have evolved significantly over the last century, with pioneers emphasizing outcome measurement and evidence-based practice. Despite some successes, we have a long road ahead to optimize and standardize evidence-based practice and measures in urology.