40 DO SHORT-TERM OUTCOMES FOLLOWING COMMON UROLOGIC PROCEDURES VARY BY THE AMBULATORY CARE SETTING WHERE THEY WERE PERFORMED?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes1 Apr 201140 DO SHORT-TERM OUTCOMES FOLLOWING COMMON UROLOGIC PROCEDURES VARY BY THE AMBULATORY CARE SETTING WHERE THEY WERE PERFORMED? John M. Hollingsworth, Julie C. Lai, Christopher S. Saigal, Christopher P. Filson, Brent K. Hollenbeck, and Urologic Diseases in America Project, Los Angeles, CA John M. HollingsworthJohn M. Hollingsworth Ann Arbor, MI More articles by this author , Julie C. LaiJulie C. Lai Santa Monica, CA More articles by this author , Christopher S. SaigalChristopher S. Saigal Los Angeles, CA More articles by this author , Christopher P. FilsonChristopher P. Filson Ann Arbor, MI More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck Ann Arbor, MI More articles by this author , and Urologic Diseases in America Project, Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.103AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The savings achieved by payers from steering urologic procedures to ambulatory surgery centers (ASCs) and physician offices (POs) may be wholly mitigated if the quality of care at these less resource-intense facilities is not comparable to that of hospital outpatient departments (HOPDs). Motivated by this concern, we assessed short-term outcomes for patients across ambulatory care settings. METHODS Using a 5% random sample of Medicare beneficiaries (1998–2006), we identified elderly adults who underwent one of 20 common outpatient urologic procedures. Through appropriate place-of-service and revenue codes, we determined the facility type at which each procedure was performed (i.e., HOPD, ASC, or PO). We then measured the incidence of same-day admissions, as well as the frequency of hospitalization, complications, and death within 30 days of the index date. Finally, we fit multivariable logistic regression models to evaluate the association between an event occurrence and the ambulatory setting where care was delivered. RESULTS Over the study period, the proportion of procedures performed at ASCs remained relatively stable. However, there was a substantial increase in frequency PO-based procedures, reflecting a shift in care away from HOPDs. While patients treated in a PO (versus a HOPD) had lower odds of experiencing an adverse event (OR, 0.90; 95% CI, 0.81–0.99), the predicted probability of any adverse event was exceedingly low irrespective of the ambulatory care setting (Figure). CONCLUSIONS These data indicate a shift in outpatient urologic care to the PO. Insofar as the care provided in these facilities is less expensive, this trend represents delivery of higher value care for payers. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e16-e17 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Hollingsworth Ann Arbor, MI More articles by this author Julie C. Lai Santa Monica, CA More articles by this author Christopher S. Saigal Los Angeles, CA More articles by this author Christopher P. Filson Ann Arbor, MI More articles by this author Brent K. Hollenbeck Ann Arbor, MI More articles by this author Urologic Diseases in America Project, Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...