MP17-06 PREDICTORS AND COST COMPARISON OF SUBSEQUENT URINARY STONE CARE AT INDEX VERSUS NON-INDEX HOSPITALS

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-06 PREDICTORS AND COST COMPARISON OF SUBSEQUENT URINARY STONE CARE AT INDEX VERSUS NON-INDEX HOSPITALS William French, Davis Viprakasit, Charles Scales, Roger Sur, and David Friedlander William FrenchWilliam French More articles by this author , Davis ViprakasitDavis Viprakasit More articles by this author , Charles ScalesCharles Scales More articles by this author , Roger SurRoger Sur More articles by this author , and David FriedlanderDavid Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Care fragmentation, or the engagement of different health care systems along the continuum of care, has been shown to negatively affect patient outcomes. There is a lack of literature on care fragmentation’s effect on urinary stone disease. METHODS: All-payer data from the 2016 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify a cohort of adult patients with an emergency department visit for a diagnosis of urolithiasis, who subsequently re-presented to an index or non-index hospital for renal colic and/or urological intervention. Patient demographics, regional data, and procedural information were collected and 30-day episode-based costs were calculated. Multivariable logistic and gamma generalized linear regression were utilized to identify predictors of surgery at an index hospital and 30-day costs, respectively. RESULTS: Of the 33,863 patients who experienced a subsequent encounter, 9,593 (28.3%) received care at a non-index hospital. Receiving care at an index hospital was associated with a decreased number of healthcare encounters prior to surgery (OR 0.89, 95% CI 0.86-0.91; p <0.001) and fewer days to surgery (OR 0.998, 95% CI 0.997 – 0.998; p < 0.001). Predictors of receiving care at an index hospital included increasing Elixhauser Comorbidity score (≥3 vs. 0: OR 1.34, 95% CI 1.20-1.48; p < 0.001) and the presence of renal insufficiency (OR 1.21, 95% CI 1.10-1.32; p < 0.001). Undergoing any type of urologic intervention (Percutaneous nephrolithotomy: OR 0.61, 95% CI 0.48-0.77, p < 0.001; Ureteroscopy: OR 0.85, 95% CI 0.74-0.98, p=0.027; Shockwave lithotripsy: OR 0.64, 95% CI 0.52-0.80, p < 0.001; Stent: OR 0.82, 95% CI 0.74-0.92, p < 0.001; Nephrostomy tube: OR 0.76, 95% CI 0.59-0.96, p=0.021), living in a rural area (OR 0.55, 95% CI 0.42-0.73; p < 0.001) and being covered by Medicare (OR 0.85, 95% CI 0.78-0.93; p=0.001) significantly lowered the likelihood of an index presentation. 30-day episode-based costs were higher in the non-index setting, with a mean difference of $698.81 (Non-index: $13,672.21, 95% CI $13,291.71 - $14,052.72; Index: $12,889.15, 95% CI $12,676.53 - $13,101.77; p < 0.001). CONCLUSIONS: Non-index pathways of care following an initial diagnosis of urolithiasis are associated with more health encounters, longer times to definitive surgery, and increased costs. Strategies to improve care coordination following a diagnosis of urolithiasis are likely to improve patient experience and episode-based spending. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e310-e310 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information William French More articles by this author Davis Viprakasit More articles by this author Charles Scales More articles by this author Roger Sur More articles by this author David Friedlander More articles by this author Expand All Advertisement Loading ...