Learn about the National Association For Continence's Center of Excellence: Continence Care in Women designation.

1. Center of Excellence in
Continence Care

2. Centers of Excellence in Continence Care:
Goals and Objectives
• Create a credible, legitimate vehicle to facilitate consumer
access to high quality care
• Establish a fair and transparent process for all applicants, also
acceptable to payers and the public at large
• Remain loyal to our mission as a patient advocate and
representative.
• Own a database of patient satisfaction ratings to create and
maintain benchmarks for continuous quality improvement
• Manage a self-sustaining enterprise, without undue
distraction to our ongoing education programs
• Strengthen NAFC’s reputation as an independent and credible
source to guide the consumer in seeking healthcare

3. Cases gone wrong….unexpected outcomes

4. Proving correct: The whispers among women
A landmark multicenter
study published in 2007:
Documented stringently
defined success rates –
including patient
satisfaction scores - of
49% for the Burch and
66% for the fascial sling
two years post-op,
deteriorating to 22% and
30%, respectively five
years out.

5. Many Communities Lack Specialty Trained,
Experienced Doctors
And while the new
subspecialty in Female
Pelvic Medicine &
Reconstructive Surgery,
administered jointly by
ABU and ABOG, will help
with consistent,
comprehensive fellowship
training, numbers will
remain small and largely
contained in academic
medical centers.

6. A Growing Interest in Measuring
Consumer Perceptions
This study surveys over 250,000
households representing over
450,000 consumers in the
contiguous 48 states and the District
of Columbia. From the households
surveyed, 3200 hospitals named by
consumers are analyzed and ranked
based on their Core Based Statistical
Areas (CBSAs) as defined by the U.S.
Census Bureau, with the winning
facilities being ranked the highest:
Top of mind perceptions (image,
reputation, advertising recall, etc.)
but not detailed, actionable data,
especially for multidisciplinary care
that may include community
providers.

7. Standards for Patient Satisfaction
• Outcomes that fail to meet patient expectations and dissuade
consumers from seeking diagnosis and treatment
• The focus of payers on penalties for NEVER events and readmissions
instead of patient satisfaction with quality of care and outcomes
• Fragmentation, competition, and disagreement among providers as
to preferred, evidence-based protocols for diagnosis and treatment
• Providers lacking experience and/or sufficient surgical training
 Misdiagnosis
 Misinformation
 Poorly executed choices and patient selection for certain
procedures
 The need for costly repeat surgeries and second opinion

8. Provider Centered
Outcomes
Patient Centered
Outcomes
Pad use Cough stress test
Voiding frequency Pelvic floor distress
inventory questionnaire
Health-Related Quality
of Life questionnaire
POP-Q system
Global impressions of
improvement
Post-void residual urine
volume
Improvement in
symptoms, including
new complications
Overall satisfaction,
including pain
management
Confidence in the
treatment technology
and willingness to
recommend to others
Cleanliness, ease of
navigating, and safety
of the facility including
signage, parking, etc.
Education about one’s
condition and
involvement in
treatment plans
Satisfaction with
quality of nursing care
Access to one’s doctor
for appointment times
and dates desired by
the patient
Adequate preparation
by the clinic or
discharge nurse for
self-care by patient
COE: Establishing a New Set of Benchmarks

9. The COE Requirements
1. Demonstrated commitment to excellence by upper management,
in both clinical services and research.
2. Organization-wide quality improvement and safety initiatives
operative.
3. Verification of experience: >150 PFD surgical cases lifetime and
>100 surgical cases in the most recent 12 months by each
primary operating physician, post fellowship training.
4. An organization, with a Medical Director of the Pelvic Floor
Clinic/Department
5. Integrated, full-time, multi-disciplinary team including
gynecologists, urologists, colorectal surgeons,
gastroenterologists, nurse practitioners, physical/occupational
therapists trained in PFD diagnosis and treatment
6. Full line of diagnostic and therapeutic equipment, e.g.
urodynamics

10. The COE Requirements (cont.)
7. Fellowship trained PFD surgeons and evidence of ongoing medical
society involvement
8. Standardized, clinical pathways and protocols, including
perioperative care practice guidelines in writing
9. Formally trained, designated nurses and allied health
professionals, e.g., SUNA or WOCN nurse training and
certification.
10. Patient education materials in print and online and a
demonstrated commitment to community health literacy
11. Means of computerized tracking of all PFD patients for at least
two year follow-up data and analysis
12. No litigation pending or in the most recent three years involving
patient harm or abuse.

11. 1. Go to www.nafc.org, click on the logo in the
lower left corner, and then click on “Process” to review
the requirements. Make sure you meet case volume
requirements. Two or more physicians must apply
together, with a hospital where surgeries are
performed.
2. Download the physician and institutional application
forms. These must be returned with CVs and an
organizational chart illustrating how the Center fits into
the clinic’s or institution’s reporting structure.
How To Apply

12. The COE Application and Review Process
Step #1: Hospital ($1,500) and Physicians ($300 each) submit
separate applications
Step #2: Surveys are mailed to a sample of patients (95% Confidence
Level, +/- 10% Confidence Interval)
Step #3: Survey analysis and interpretation: PowerPoint presentation
and discussion
Step #4: Site Visit
Step #5: Report and Recommendation to the Committee
Step #6: Designation, Rejection, or 2-Year Provisional
Step #7: Three Year Designation ($4,500 hospital fees plus $700
physician fees)

13. Month 1 – Obtain and complete applications. Applications are submitted
with application fees ($300 MD and $1,500 hospital).
Month 2 – Applications reviewed by NAFC, entered in database, and
any missing information requested.
Month 3 – Applicants generate mailing list of patients and provide to
mailing house for NAFC survey.
Month 4 – Survey is mailed.
Month 5 – Results are tabulated. Site visit is scheduled
Month 6 – Site visit takes place. Survey results shared.
Month 7 – Full report is written and submitted to Review Committee.
Month 8 – Review Committee discusses and issues questions or
requests of applicants or approves.
Month 9 – Press release is issued. Certificate is shipped for framing and
display. Website sections are created. Balance of fees are paid.
Timeframe for Completing Application Reviews and
Center of Excellence Designation

14. Patient Survey Structure
 Overall Patient Experience and
Health Status Following
Treatment
 Patient Satisfaction with
Facility (including scheduling,
nursing staff, check-in,
discharge, etc.)
 Patient Satisfaction with
Physician (including evidence
of shared decision-making)

15. Two-Day Site Visit Itinerary
 Each Applicant Physician
 Administrative Manager
 Nursing Supervisor, Clinic Nurses
 Physical Therapist
 Collaborative Physicians (e.g., Colorectal Surgeon)
 Research Nurse Coordinator
 Sr. VP Operations for the Facility/COO/CEO
 Manager of Contracting Services
 Director of Marketing and Media Relations
 Department Chairman
 Pelvic Floor Clinic Medical Director
 Patient Ombudsman/Patient Guest Services
 Nurse Practitioner – Patient Education or Pessary Specialist

16.  Evidence of a demonstrated commitment to excellence, in both
clinical services and in research
 Quality improvement and patient safety initiatives that are fully
operative
 Verification of PFD experience and training claims of physician
applicants
 Evidence of a team that functions as an organizational unit, with
its own medical director
 Evidence of access to multi-disciplinary talent, with PFD training
in diagnosis and treatment
Site Visit: Topics Covered

17.  Leadership involvement in medical societies
 Written standards of care and clinical pathways
 Formally trained and/or certified nurses on staff
 Use of objective, up to date patient education materials and
commitment to community education
 Means of tracking patient outcomes >/= 2 years
 Full line of diagnostics and therapeutic equipment
 No litigation involving patient abuse or malpractice </= 3 years
Site Visit (continued)

18. Final COE Designation

19. Publicity of Centers of Excellence in Continence Care

20. The 2012 Review Committee
 Willy Davila, MD (Cleveland Clinic)
 Sal Giorgianni, PharmD (Retired)
 Brooke Gurland, MD (Cleveland Clinic)
 Fatima Hakeem, PT (Woman’s Hospital)
 Cheryl Iglesia, MD (Washington Hospital)
 Peter Lotze, MD (OBGYN Associates)
 Alvaro Lucioni, MD (Virginia Mason)
 Alayne Markland, DO (UAB)
 Lynn Nye, PhD (Medical Minds, Inc.)

21. End of COE Portion of Presentation
Questions?

22. Mission of NAFC
As one of the world’s largest, oldest, and most prolific public
education and patient advocacy organizations in the field, it is
NAFC’s mission: 1) to educate the public about the causes,
diagnosis categories, treatment options, and management
alternatives for bladder and bowel control problems, voiding
dysfunction and related pelvic floor disorders; 2) to network with
other organizations and agencies to elevate the visibility and
priority given to these areas; and 3) to advocate on behalf of
patients who suffer from such symptoms as a result of disease or
other illness, obstetrical, surgical or other trauma, or deterioration
due to the aging process itself. NAFC is broadly funded by
consumers, healthcare professionals and industry.

23. Constituency Served
- Men, Women, and Older
Children and Teens
- Young mothers
- Young adults who have
sustained SCI accidents
- People with neurological
diseases and conditions (PD,
MS, stroke survivors, etc.)
- The elderly and infirmed
- Menopausal women
- Post-prostatectomy men

24. NAFC Programs and Activities
Website traffic: >40,000 monthly
Printed patient education materials

25. NAFC’s Advocacy Voice
• Urging FDA approval of new,
advanced medications and
devices to give patients
access to proven, advanced
technology…and sustain their
hope
• Urging AMA to assign discrete
codes to new products
• Urging CMS and private
payers to provide coverage
and reimbursement of
treatment options

26. Helping Consumers Find An Expert
• Consumers are increasingly
distrustful of health information
online:
• Competing sources of information
use different metrics,
methodologies and data sources,
fielding contradictory and
confusing quality data
• Word of mouth (50%) and
physician referrals (38%) still
drive the majority of doctor
selection by consumers,
especially when choosing
specialists or facilities for medical
procedures. Two in five rely on
multiple sources. Only 3-11% rely
on online provider databases.

27. Influential Trends
- The call for improving safety (IOM, 1999)
- Growing focus on patient centered healthcare
- Application of evidence-based healthcare (“Not about us without
us”)
- Shifting more costs and responsibility for self-care onto the patient

28. Center of Excellence in
Continence Care