499 UROLOGIST INTENSITY IN THE INITIAL EVALUATION OF ELDERLY MEN WITH BPH

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2010499 UROLOGIST INTENSITY IN THE INITIAL EVALUATION OF ELDERLY MEN WITH BPH Seth Strope, John T. Wei, Timothy Wilt, Christopher Saigal, and Sean Elliott Seth StropeSeth Strope St. Louis, MO More articles by this author , John T. WeiJohn T. Wei Ann Arbor, MI More articles by this author , Timothy WiltTimothy Wilt Minneapolis, MN More articles by this author , Christopher SaigalChristopher Saigal Los Angeles, CA More articles by this author , and Sean ElliottSean Elliott Minneapolis, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.574AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although urologists play a major role in the evaluation and treatment of BPH, little is known about their contemporary practice patterns. We sought to describe variations in the physician-level intensity of evaluation for elderly men with BPH/LUTS within their first year of a visit to an urologist. METHODS Using a 5% national sample of Medicare beneficiaries for the years 1999 to 2007, we developed a cohort of men with new visits to an urologist for a diagnosis consistent with BPH or LUTS. Evaluations performed by the urologists were tabulated for each patient, and the overall intensity of evaluative care (using total Medicare expenditures on evaluative BPH care standardized for calendar year and geography) for each provider was determined. Physician characteristics and the profile of the average patient cared for by these physicians were defined for each quintile of urologist intensity. Differences in the rates of each evaluative service (among high vs. low intensity providers) were assessed by regression analysis. RESULTS Amongst a cohort of 748 U.S. urologists evaluating 10,248 new patients with BPH/LUTS, Medicare expenditures for patients treated by the highest intensity providers were substantially higher than for patients treated by the lowest intensity providers ($1195-2014 highest quintile compared to $426-780 lowest quintile). The prevalence of high intensity urologists was greatest in the Northeast and lowest in the Midwest (38.3% and 8.0% highest intensity respectively; p < 0.001) and amongst physicians caring for patients of high socioeconomic status. Overall, high intensity urologists performed a higher rate of each type of care than low intensity urologists (Figure 1). The biggest differential was in urodynamics (rate ratio for high vs. low = 7.2, p < 0.001). The smallest difference was in urinalysis (rate ratio = 1.6, p < 0.001). CONCLUSIONS Higher intensity urologists performed significantly more of each evaluative test for men with BPH compared to lower intensity urologists. These differences in practice reveal substantial differences in the urologic community about how to manage a new patient with BPH. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e197 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seth Strope St. Louis, MO More articles by this author John T. Wei Ann Arbor, MI More articles by this author Timothy Wilt Minneapolis, MN More articles by this author Christopher Saigal Los Angeles, CA More articles by this author Sean Elliott Minneapolis, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...