Quality of care in urology

grade, pathological stage, etc., and treatment has often been based on single-institution retrospective experience. These studies have commonly ignored potentially modifiable clinical factors, structures and processes that are measured by their association with morbidity, mortality and length of stay (LOS). One of the recognized fathers of quality of care initiates, Avedis Donabedian, was a Professor of Public Health at the University of Michigan for many years. He described quality of care through three components, i.e. structure, process and outcomes [2]. Structure is related to the support from the system and includes hospital equipment and support, training of individual surgeons, and patient volume of an individual surgeon or hospital. Process, on the other hand, relates to the actual care provided and usually relies on evidence-based medicine (e.g. prophylaxis for deep vein thrombosis). Unfortunately, in urology there are few data on specific process measures that are known to make a difference. The most commonly used measure of quality is outcome, which is reflected by morbidity, complication rates, mortality rate, functional health outcomes commonly referred to now as ‘quality-of-life assessments’, patient satisfaction evaluations, and costs. Urologists have previously not approached quality from an inclusive viewpoint; unfortunately, they have often focused on one set of outcome measures, which are those most easily obtained from a retrospective chart analysis.