314 NEW CARE COORDINATION SYSTEM IMPROVES THE QUALITY, EFFICIENCY AND COST OF CARE FOR PATIENTS WITH HEMATURIA

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 2011314 NEW CARE COORDINATION SYSTEM IMPROVES THE QUALITY, EFFICIENCY AND COST OF CARE FOR PATIENTS WITH HEMATURIA Jessica T. Casey, John Cashy, Amy Tourne-Schwab, Nilmini Wickramasinghe, Anthony J. Schaeffer, Christopher M. Gonzalez, and Lyle L. Berkowitz Jessica T. CaseyJessica T. Casey Chicago, IL More articles by this author , John CashyJohn Cashy Chicago, IL More articles by this author , Amy Tourne-SchwabAmy Tourne-Schwab Chicago, IL More articles by this author , Nilmini WickramasingheNilmini Wickramasinghe Melbourne, Australia More articles by this author , Anthony J. SchaefferAnthony J. Schaeffer Chicago, IL More articles by this author , Christopher M. GonzalezChristopher M. Gonzalez Chicago, IL More articles by this author , and Lyle L. BerkowitzLyle L. Berkowitz Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As microscopic and gross hematuria are common urologic referrals with a defined best practice pathway for evaluation, we sought to determine if inclusion of a care coordination system to manage the referral process would lead to improved quality, efficiency and economic outcomes. METHODS A care coordination system was developed which included the primary care physician's use of a standardized “Hematuria Pathway” checklist which included orders for a CT scan followed by a urology referral with cystoscopy. A care coordinator facilitated the ordering process and reviewed the progress at 4 weeks to ensure completion. This system was used for patients referred for hematuria from May 2009 to May 2010. The outcomes for these “navigated” patients (group A, n=106) were compared to patients referred to our urology department for hematuria during the same time period who did not use a care coordination system (group B, n=105). RESULTS Demographics, presenting symptoms, and final diagnoses were equal between groups, and there was no significant difference in the percentage of patients who completed the entire hematuria work-up (55.7% A vs. 47.6% B, p=0.24) or were seen by urology (84.0% A vs. 77.1% B, p=0.21). However, patients in group A completed their evaluation in significantly shorter times with decreased time between the diagnosis of hematuria and completion of the CT scan (22.0 vs. 45.2 days, p<0.05) and completion of cystoscopy (35.8 vs. 70.6 days, p<0.05). Additionally, more patients in group A had their CT scan completed prior to their first urology visit (75.5% vs. 28.6%, p<0.05). Also, group A had more patients who completed their evaluation in one urology visit (56.6% vs. 21.9%, p<0.05). CONCLUSIONS Incorporating a care coordination system into the referral process for hematuria decreased the time to complete evaluation. Timeliness, one of the Institute of Medicine's quality metrics, is particularly important for this situation as 3.8% of patients had a new cancer diagnosis. Additionally, increasing the number of CT scans done prior to the first urology visit resulted in less total urology visits per evaluation. This finding should result in decreased cost to patients and payors, as well as increased access to care for others as more appointments will be open. It is estimated there are 500,000 to 1,000,000 hematuria evaluations per year in the U.S., so removing an initial visit with a cost of $100 could save the healthcare system approximately $50 to $100 million per year. Further analysis of the economic and quality ramifications of this care coordination system is under way. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySchaeffer A (2018) Electronic Medical Records and Data Warehouses Improve Patient Care and Reduce CostsJournal of Urology, VOL. 186, NO. 1, (7-8), Online publication date: 1-Jul-2011. Volume 185Issue 4SApril 2011Page: e127-e128 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica T. Casey Chicago, IL More articles by this author John Cashy Chicago, IL More articles by this author Amy Tourne-Schwab Chicago, IL More articles by this author Nilmini Wickramasinghe Melbourne, Australia More articles by this author Anthony J. Schaeffer Chicago, IL More articles by this author Christopher M. Gonzalez Chicago, IL More articles by this author Lyle L. Berkowitz Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...