Adhering to Clinical Advice: The Level of Alignment of Care Processes With Global Bladder Guidelines in Veterans With Spinal Cord Injuries or Diseases.

Background: Guidelines contain recommendations for monitoring and care of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury/disorder. Evidence on the level of adherence to these recommendations is limited.

Objectives: To assess treads in proportion of patients with spinal cord injury/disorder receiving commonly recommended processes of care for NLUTD.

Methods: The cohort consisted of 49 326 veterans with supra-sacral spinal cord injury or disorder (SCI/D) within the Veterans Affairs (V.A.) healthcare system first seen from fiscal year 1999-2024. Measures included laboratories, imaging, bladder-care procedures, and whether the veteran was seen by a urologist and had cystometrography (CMG).

Results: The analysis reveals the use of recommended NLUTD monitoring processes, with 41% undergoing renal imaging, 48% having a urology encounter, and 31% receiving cystometrography. A longitudinal view shows a decline in these rates over time. However, CMG rates exhibited some increase in veterans entering the system between 2005 and 2014, indicating a slight improvement in adherence over time.

Conclusions: The study highlights gaps between current practices and recommended processes for NLUTD, which may compromise outcomes for veterans with supra-sacral SCI/D. Further research is necessary to explore the barriers to executing suggested processes and implications for outcomes of this vulnerable population.