265 UROLOGISTS AND THE PATIENT-CENTERED MEDICAL HOME

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2010265 UROLOGISTS AND THE PATIENT-CENTERED MEDICAL HOME John M. Hollingsworth and David C. Miller John M. HollingsworthJohn M. Hollingsworth More articles by this author and David C. MillerDavid C. Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES One of the most widely-discussed delivery-system reforms is the medical home. At present, most models emphasize the need for primary care practices to manage comprehensively their patients' chronic care needs, but the medical home is in theory neutral with respect to the specialty of a patient's doctor. Therefore, it may be possible for urology practices to function as medical homes for patients with certain chronic conditions, including genitourinary (GU) cancers. Implementation of this model would require transferring some or all of the care for these conditions that primary care physicians (PCPs) currently provide to urologists and urology practices. To explore the feasibility of this approach, we estimated the implications of consolidating GU cancer follow-up care among the existing urology workforce. METHODS Using the 2007 National Ambulatory Medical Care Survey, we abstracted adult ambulatory visits to PCPs and urologists for 4 GU cancers (prostate, bladder, kidney, and testis). We first determined the amount of time that PCPs spent in direct (i.e., face-to-face contact) and indirect care (e.g., reviewing and interpreting laboratory results) for their established patients with these conditions. We then measured the time burden (in terms of annual 55-hour work weeks) associated with consolidating half of this follow-up care among the current supply of urologists. RESULTS In total, 26.8% of GU cancer-related visits were to PCPs, nearly all of which (95.2%) were for follow-up care. On average, PCPs spent 19.5 minutes with each established patient during a visit for a GU cancer. Summing across the 1.7 million return cancer visits to PCPs, this translated into 9,583 work weeks of direct care. PCPs spent an additional 1,551 work weeks in indirect care. Transferring 50% of this GU cancer care would generate nearly one additional work week for each actively-practicing urologist (Figure), a time commitment equivalent to expanding the urology workforce by 107 surgeons. CONCLUSIONS Our results demonstrate that consolidation of GU cancer follow-up is feasible. As such, urology practices would make logical medical homes for patients with these conditions. Ann Arbor, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e104-e105 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Hollingsworth More articles by this author David C. Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...